This job is no longer available
SFM Mutual Insurance has distinguished itself as workers’ compensation experts and we take great pride in servicing our customers by bringing quality services, cost control and specialized workers’ compensation insurance expertise to employers throughout the Midwest region. We are committed to hiring people who have passion for what they do and are dedicated to making a difference.
SFM Mutual is seeking a Medical Director to provide leadership in achieving maximum results related to cost-effective and quality medical decisions. Provides visionary direction, technical oversight and direct support to telephonic medical case management staff in application of medical management policies, practices and procedures. Works closely with applicable state and federal regulatory agencies and keeps apprised of all rules, procedures and forms related to the delivery of medical care to injured employees. Accountable for quality management over telephonic medical case management staff via periodic internal audits. Conducts trend analyses on medical costs and practice. Determines the need for and delivery of staff training. Develops and maintains provider relationships within the medical community to improve treatment results and cost effectiveness of services. Responsible for negotiating contracts with health care providers and for establishing and maintaining a vigorous reporting and quality management process. Oversees services provided by the physician advisors, independent contractors, consulting services and/or the medical community. Partners with Claims Technical Specialists to establish reserve guidelines and provide quality review support related to medical best practices. Oversees bill review function, including on-site technical support and partnership with bill review vendor.
SFM offers a competitive salary, comprehensive benefits package, incentive bonus based on company and team goals, flexible work arrangements, and a career-enriching environment. For more information about SFM or to apply online please visit our website at www.sfmic.com.
- RN Credentials with current MN license.
- Master’s degree in public health, business, nursing, healthcare and/or insurance or related field.
- Eight-plus years’ progressive experience in healthcare/insurance/management required.
- Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS) or Certified Rehabilitation Registered Nurse (CRRN) designation preferred.
- Working knowledge of case management, utilization review and quality improvement.
- Effective leadership and supervisory skills.
- Broad insurance knowledge with a specialization in workers’ compensation and/or casualty.
- Ability to establish effective relationships with members of the medical community (physicians, hospitals and related medical providers).
- Strategic, analytical, planning and operations implementation skills.
- Exceptional verbal and written communication skills in order to interact in a team environment and to collaborate with other business units for information gathering, reporting results, training, etc.
- Strong skills in teamwork, negotiation, conflict management, problem solving, effective decision making and cooperative relations with diverse internal and external stakeholders.
- Effective organizational skills including the ability to manage multiple projects and work with minimal direction.
- Proven ability to assess complex issues, recommend change and resolve issues.
- Ability to negotiate vendor contracts according to corporate standards.
- Excellent analytical and documentation writing skills.
- Coaches, guides and encourages staff toward improved performance.
- Inspires innovation and continuous quality improvement.
- Highly developed ability to build consensus and manage change effectively.
- Presents as a positive role model by mentoring and collaborating with internal and external customers.
- Ability to apply confidentiality when appropriate.
- Strong project management skills.
- Strong presentation skills.
- Excellent computer skills and ability to quickly learn new software applications and programs.