Health Services Supervisor (Pre-Cert)
Apply NowCompany: Chesapeake Employers' Insurance Company
Location: Towson, MD 21204
Description:
Who We Are
Chesapeake Employers' Insurance Company is a purpose-driven organization dedicated to improving the lives and livelihoods of our policyholders, injured workers, team members, and the community. As a leading workers' compensation specialty insurer in the mid-Atlantic region, we take pride in being a force for good. Our 350 team members are committed to making a positive impact every day in the lives of all our stakeholders. Join our motivated, professional team as we foster a culture of values, teamwork, innovation, and collaboration. Established in 1914, Chesapeake Employers Insurance, headquartered in Towson, Maryland, has over a century of experience, a strong financial foundation, and an "A" rating from AM Best.
POSITION SUMMARY
Oversees nurse case managers to ensure quality, efficiency, and accuracy in the processing of medical services transactions.
DUTIES AND RESPONSIBILITIES
SKILLS, EDUCATION, AND EXPERIENCE
POSITIONAL COMPETENCIES
PHYSICAL DEMANDS
While performing the duties of this job, the employee is regularly required to sit, use hands to handle objects, tools, or controls, and reach with hands and arms.
The employee is occasionally required to stand, walk, stoop, kneel, crouch, or crawl.
The employee may occasionally lift up to 30 pounds.
Specific vision abilities required include close vision, peripheral vision, and the ability to adjust focus.
WORK ENVIRONMENT
Office environment with moderate noise levels.
Salary Range: $89,910 - $139,360 per year (commensurate with experience)
What We Offer
We offer a competitive benefits package that includes health, vision, and dental coverage, a robust PTO plan, an 8% employer contribution to retirement regardless of team member contribution, educational assistance, and opportunities to participate in team member appreciation events. Additionally, we provide STD, LTD and group life insurance 1X a team members salary. You'll also enjoy free tickets to community attractions, all part of our commitment to providing a high quality of work life. You will have the flexibility to thrive in a hybrid work environment and an opportunity to participate in development and volunteer programs.
Chesapeake Employers' Insurance Company is a purpose-driven organization dedicated to improving the lives and livelihoods of our policyholders, injured workers, team members, and the community. As a leading workers' compensation specialty insurer in the mid-Atlantic region, we take pride in being a force for good. Our 350 team members are committed to making a positive impact every day in the lives of all our stakeholders. Join our motivated, professional team as we foster a culture of values, teamwork, innovation, and collaboration. Established in 1914, Chesapeake Employers Insurance, headquartered in Towson, Maryland, has over a century of experience, a strong financial foundation, and an "A" rating from AM Best.
POSITION SUMMARY
Oversees nurse case managers to ensure quality, efficiency, and accuracy in the processing of medical services transactions.
DUTIES AND RESPONSIBILITIES
- Provides leadership to all Pre-Cert and IME Medical Services groups.
- Collaborates with the Medical Services Manager to implement, manage, and evaluate policies and procedures for assigning cases for medical management.
- Manages caseloads by measuring case assignments, closures, outcomes, and utilization review standards.
- Ensures maximum caseloads across case managers and units.
- Oversees unit nurse case managers to ensure timely and accurate delivery of departmental services in compliance with WCC, Chesapeake Employers', and other industry protocols.
- Establishes goals and KPIs, provides direction, and evaluates direct reports to ensure superior service for all stakeholders.
- Develops the NCM department through hiring, staff development initiatives, and educational opportunities.
- Conducts NCM audits and provides coaching to Senior NCMs on audit processes.
- Coordinates with the IS department and vendors to enhance systems and maximize resource utilization.
- Works closely with claims staff to improve communication and coordination of information.
- Resolves medical provider and vendor issues through direct communication or delegation to appropriate staff.
- Prepares reports and other requested documents for leadership.
- Provides leadership support for new initiatives.
- Collects and analyzes data to develop system models and program direction aligned with business plans.
- Reviews current literature to stay informed on medical policy, professional requirements, and industry trends.
- Oversees clinical program referrals, usage, and outcomes tracking.
- Ensures superior customer service delivery.
- Performs other duties as assigned.
SKILLS, EDUCATION, AND EXPERIENCE
- Bachelor's degree preferred.
- Minimum of 6-10 years of work experience, with at least 2 years in case management/workers' compensation required.
- 3 to 5 years of progressive management experience preferred.
- Knowledge of WCC procedures, including WCC fee guidelines.
- Current Maryland RN License required.
- MCRSP certification from WCC required.
- CCM certification preferred.
- Bilingual skills preferred.
POSITIONAL COMPETENCIES
- Pursuing Excellence
- Making a Difference
- Leadership Presence
- Excellent Communication Skills
- Maintaining Focus and Accountability
- Strategic Initiative
- Developing People
- Attention to Detail
PHYSICAL DEMANDS
While performing the duties of this job, the employee is regularly required to sit, use hands to handle objects, tools, or controls, and reach with hands and arms.
The employee is occasionally required to stand, walk, stoop, kneel, crouch, or crawl.
The employee may occasionally lift up to 30 pounds.
Specific vision abilities required include close vision, peripheral vision, and the ability to adjust focus.
WORK ENVIRONMENT
Office environment with moderate noise levels.
Salary Range: $89,910 - $139,360 per year (commensurate with experience)
What We Offer
We offer a competitive benefits package that includes health, vision, and dental coverage, a robust PTO plan, an 8% employer contribution to retirement regardless of team member contribution, educational assistance, and opportunities to participate in team member appreciation events. Additionally, we provide STD, LTD and group life insurance 1X a team members salary. You'll also enjoy free tickets to community attractions, all part of our commitment to providing a high quality of work life. You will have the flexibility to thrive in a hybrid work environment and an opportunity to participate in development and volunteer programs.