Excess Risk Managed Care Coordinator

Excess Risk Managed Care Coordinator

Pittsburgh, PA

 

HM Insurance Group, headquartered in Pittsburgh, PA, offers a connected product portfolio of products and services that help to provide health risk solutions for clients and presently has an opening for a Excess Risk Managed Care Coordinator.  The HM Insurance Group product portfolio includes Stop Loss, including medical reinsurance programs such as Provider Excess and HMO Reinsurance, as well as Limited Benefit Medical and Worksite.

 

This position is accountable for managed care results for all Excess Risk claim units which consists of 500 ? 700 groups working with as many as 70 different Third Party Administrators (TPA) and their associated internal or external Utilization Review and/or Case Management staff or vendors. This includes coordination of all managed care activity, Case Management oversight of all TPA partners and timely network steerage activity where applicable. This position is also responsible for providing pre-sale and renewal support to Underwriting in evaluating potential claims that affect the risk.  This position requires the incumbent to develop effective, professional working relationships with Claim Examiner Staff, the Director of Claim Administration, the Underwriting Staff, the National Sales Staff, the Human Resource Staff and all Third Party Administrators and their vendors nationally.

 

To successfully meet the requirements of the position the candidate must have a Bachelor?s degree in Nursing or four years of case management experience.  CCM certification is required.  Also required is a current R.N. license, minimum of one year experience in case management in a clinical setting, and a minimum of three years in the insurance industry.  Other qualifications include demonstrated thorough working knowledge of the excess risk product, both specific and aggregate coverages and related claim management techniques including case management and other cost containment measures; strong understanding of self-funding, Third Party Administration and Managed Care; excellent project management, time management, communication and organizational skills.

 

HM Insurance Group offers a competitive salary and excellent benefits.  Qualified candidates please forward resume to: HM Insurance Group, Suite P7506, PO Box 535061, Pittsburgh, PA 15253-5061.  Fax: (412) 544-0790.  E-mail: HLCemploy@hminsurancegroup.com   HM Insurance Group is an Equal Opportunity/Affirmative Action employer.  HM Insurance Group strives to capitalize on the strengths of individual differences and the advantages of an inclusive workplace.  EOE M/F/D/V