Sr Vice President Managed Care
PMA Companies · Blue Bell, Pennsylvania, US
The Senior Vice President, Managed Care is responsible for directing, managing, and leading PMA Companies' Managed Care Department. This includes maximizing...
Job description
The Senior Vice President, Managed Care is responsible for directing, managing, and leading PMA Companies' Managed Care Department. This includes maximizing every opportunity to provide appropriate, quality care while addressing workers' compensation medical and pharmacy utilization and cost data at a granular level. PMA's Managed Care programs include: Network Solutions, Bill Repricing and Negotiation, Clinical Solutions, Pharmacy Solutions, Business and Customer Support and Business Analytics. This role also supports Old Republic's Third Party Administrator (TPA) operations by ensuring Managed Care services, pricing approaches, and program performance align to TPA client needs and growth objectives. Responsibilities: - Maintain a comprehensive, fully integrated Managed Care model: - Operate a Clinical Management Program which leverages Utilization Review, specialized RN units and technology - Deliver Pharmacy Solutions which include formulary management, nurse specialists, intervention programs aimed at cost reduction & avoidance, fraud, waste and abuse - Maximize the impact of networks and bill review solutions by leveraging core and specialty networks supported by complex inter...