Director, Managed Care Services and Vendor Management

Responsibilities

• Design and execute medical management strategies to support early intervention and timely return-to-work outcomes
• Manage and develop the Managed Care Services team and foster collaboration with Claims Adjusters
• Oversee external medical management vendors including pharmacy, utilization review, case management, and IME providers
• Develop vendor strategy, including selection, onboarding, and enforcement of SLAs and KPIs
• Conduct regular vendor scorecards, audits, and business reviews to drive efficiency
• Partner with Claims leadership to align medical interventions with the claim lifecycle
• Drive initiatives to reduce medical spend and avoid opioid overutilization
• Implement standardized workflows and identify opportunities for automation and technology enablement
• Manage departmental budget and evaluate ROI of medical management programs
• Ensure compliance with state-specific Workers’ Compensation statutes and treatment guidelines
• Monitor and report on key metrics such as medical severity trends and cost per claim

Requirements

• 5+ years of progressive experience in Workers’ Compensation Medical Management, claims operations, or medical vendor oversight
• 3+ years of previous management experience
• Deep knowledge of Workers Compensation medical delivery models and regulatory environments
• Demonstrated success managing complex, multi-state medical vendor relationships
• Strong analytical, financial, and negotiation skills
• Clinical background (RN, CCM) or extensive experience partnering with clinical teams
• Bachelor’s degree in Business, Healthcare Administration, Nursing, Risk Management, or related field preferred

Preferred Qualifications

• CPCU, CWCP, CCM, ARM, or similar designation
• Experience supporting claims or medical transformation initiatives

About the Company

MEMIC is a workers' compensation provider focused on delivering high-quality, cost-effective care for injured workers while supporting optimal claim outcomes.