Director Medical Management Nursing Services

Our Claims team is seeking a Director of Medical Management Nursing Services. This is a full time, exempt role. This is a remote or hybrid opportunity out of the Worcester, MA office. POSITION OVERVIEW: Responsible for the strategic oversight and countrywide management of claims clinical nursing products and services and managing and leading Medical Managers and their employees within Medical Strategy, supporting all injury lines of business. Delivers effective leadership, technical and clinical direction, performance management, communication, relationship building, decision making, and customer service. Develops and drives execution of our strategic initiatives and our most important processes to deliver high quality service and results. Ensures related nursing products and services are developed, supported, and managed by evidence-based medical treatment guidelines. Expertly seeks nursing and product improvement and innovation to address clinical issues that directly impact claim outcomes and customer experience. Potential to manage strategic external vendor partnership and programs to ensure compliance with Service Level Agreements. Participates in special projects and assignments. Responsible for assessing the present and future resource needs for employees and providing the leadership, mentoring and guidance necessary to build and sustain a high performing workforce. IN THIS ROLE, YOU WILL: Develop and execute key strategic initiatives and operational processes to drive improved results. Management and oversight of processes/initiatives to ensure cost effective operations. Ensure high quality standards in nurse claims work product are met by adherence to guiding principles. Provide analysis through key metrics to measure and ensure initiatives are successful. Provide innovative solutions to improve our nurse claim outcomes, processes, and protocols. Ongoing activities associated with work product quality. Accountable for monitoring performance through various identified methods, provide feedback and coaching and take appropriate action. Solicit and act on internal customer feedback on escalated claims. Develop, recommend, and authorize implementation of continuous improvement initiatives which may result in cost effective enhancements in quality and service. Identify key issues and communicate to the proper audience in an appropriate and timely manner. Act as an expert resource for direct reports, other teams, business units and claims leadership. Lead and/or participate in initiatives that support claims strategies and financial goals. Interact effectively with the SLT and act as a backfill for AVP as needed. Talent/Performance Management. Monitors volume and business plans, utilizes technology and talent management to increase efficiency and scalability to support business needs. Makes timely staffing recommendations within established models and participates in identifying the ideal candidate. Identify and provide developmental opportunities through coaching and mentoring and builds succession plans. Recognizes opportunities for technical and industry training as part of a personal and professional development program. Sets cascading goals, gives, and receives feedback, documents, and delivers performance reviews, makes salary recommendations, addresses performance issues, creates, and implements development plans while conforming to policies and other internal procedures. For assigned vendor products, manages vendor performance against established service level agreements and key performance metrics, resolves issues and identified product gaps. Supports clinical educational needs of the field through collaboration with L&D on nursing products and services, medical knowledge, and clinical/evidence-based medical guidelines, where appropriate. Works collaboratively with Product Managers, Line of Business leaders. Oversees Medical Director consultation services to ensure proper utilization, quality, and costs. WHAT YOU NEED TO APPLY: Registered Nurse with 8 years of clinical experience in acute or ambulatory healthcare setting, with related claims experience. Juris Doctor degree or commensurate legal experience or MBA preferred. Proven track record leading and managing others. Possess strong business acumen and advanced claims technical knowledge. Anticipates needs of the customer and takes a proactive approach to ensure they are met. Effectively and creatively utilizes all resources (systems, people, etc.) to manage daily operations. Flexible and able to change priorities as business needs arise. Ability to multi-task and prioritize. Teaching and coaching style of management. Serves as a role model in building effective relationships. Understands and articulates claims operations in a way that drives and achieves results. Analytical and problem-solving skills are essential; anticipates issues, seeks out and analyzes information collaboratively to propose solutions. Takes ownership for a successful resolution. Exhibits key attributes of Dynamic Leadership. Viewed as a change agent. Applies innovative thought process to solve problems and to improve outcomes. Leader amongst his or her peer group and can show examples of followership. Skilled in data analytics and the ability to switch from tactical to strategic. Effectively and diplomatically communicates with a wide-ranging audience from senior leadership to frontline adjusters/nurses. Ability to listen so the needs of the speaker can be accurately ascertained. Genuinely collaborates with a wide spectrum of individuals from senior leaders, internal business customers, agent partners to the frontline adjusting/nursing staff. Builds and fosters relationships with a focus on partnering. Influences peers to act despite having no direct authority over them. Filters and synthesize feedback provided. Proficient in the Office 360 suite, including the use of PowerPoint for presentation purposes