Medical Case Management Manager

Division or Field Office:
Claims Division
Department of Position: Medical Management Department
Work from:
Home in ERIE's Footprint Salary Range:
$95,478.00-$152,516.00*
salary range is for thislevel and may vary based on actual level of role hired for
*This range represents a national range and the actual salary will depend on several factors including the scope and complexity of the role and the skills, education, training, credentials, location, and experience of an applicant, as well as level of role for which the successful candidate is hired.Position may be eligible for an annual bonus payment.

At Erie Insurance, you're not just part of a Fortune 500 company; you're also a valued member of a diverse and inclusive team that includes more than 6,000 employees and over 13,000 independent agencies. Our Employees work in the Home Office complex located in Erie, PA, and in our Field Offices that span 12 states and the District of Columbia.
Benefits That Go Beyond The Basics
We strive to be Above all in Service® to our customers-and to our employees. That's why Erie Insurance offers you an exceptional benefits package, including:

• Premier health, prescription, dental, and vision benefits for you and your dependents.Coverage begins your first day of work.
• Low contributions to medical and prescription premiums.We currently pay up to 97% of employees' monthly premium costs.
• Pension.We are one of only 13 Fortune 500 companies to offer a traditional pension plan. Full-time employees are vested after five years of service.
• 401(k) with up to 4% contribution match.The 401(k) is offered in addition to the pension.
• Paid time off.Paid vacation, personal days, sick days, bereavement days and parental leave.
• Career development.Including a tuition reimbursement program for higher education and industry designations.

Additional benefits that include company-paid basic life insurance; short-and long-term disability insurance; orthodontic coverage for children and adults; adoption assistance; fertility and infertility coverage; well-being programs; paid volunteer hours for service to your community; and dollar-for-dollar matching of your charitable gifts each year.

Position Summary

Supervises activities of staff Nurse Case Managers. Develops and implements policies and procedures regarding the cost effective use of medical resources. Works closely with the Workers' Compensation Claims Manager on projects involving medical cost containment and Case Management. Collaborates with the Medical Management Department Manager regarding the development and review of policies and procedures.

• Successful candidate will work from home and live within ERIE's Footprint.

Duties and Responsibilities

Manages overall operations of designated area of authority. Interviews, hires, trains and directs personnel. Prepares and conducts performance assessments, coordinates discipline and oversees Employee development as required.

Coordinates staff assignments to assure coverage in compliance with state RN licenses, regulations, and workload balance.

Monitors the day-to-day operations to ensure compliance with established policies and procedures.

Communicates and consults with the Medical Director regarding medical care, policies and procedures.

Collaborates with and keeps the Manager, and the Leadership team apprised of workflow issues, staffing needs, system issues and needs for process improvement.

Develops and enhances the Managed Care Program.

Monitors medical and vocational vendor performance to ensure quality work, timeliness, cost effectiveness, service and adherence to contractual agreements.

Maintains compliance with federal and state regulations.

Oversees and participates in the development of cost projections for claims with complex medical severity.

Participates in claims file conferencing for claims of a complex medical nature.

Develops and presents informational and training programs to Agents and Policyholders throughout the Erie territory.

Compiles and reviews multiple reports for statistical and financial tracking purposes to identify efficacy and trends of Case Management.

Researches, develops and conducts continuing education programs as necessary.

Assists legal counsel in preparing for trial of unusual cases.

Duties and Responsibilities (cont'd if applicable)

The first fourduties listed are the functions identified as essential to the job. Essential functions are those job duties that must be performed in order for the job to be accomplished.

This position description in no way states or implies that these are the only duties to be performed by the incumbent. Employees are required to follow any other job-related instruction and to perform any other duties as requested by their supervisor, or as become evident.

Competencies

Collaborates (Leader)

Self-development (Leader)

Customer Focus (Leader)

Instills Trust (Leader)

Persuades (Leader)

Drives vision and purpose (Leader)

Decision Quality (Leader)

Nimble Learning (Leader)

Cultivates Innovation (Leader)

Develops Talent (Leader)

Plans and Aligns (Leader)

Values Diversity (Leader)

Ensures Accountability (Leader)

Optimizes Work Processes (Leader)

Qualifications

Current unrestricted Registered Nurse (RN) license in the state where the position is based and other assigned states as required by law. Bachelor's degree preferred. Eight years experience working with property/casualty insurance or equivalent required. Masters degree in Business, Rehabilitation, Nursing or related field preferred. Certified Case Manager (C.C.M.) preferred. Previous supervisory experience preferred. Incumbent must live in region assigned unless a change is approved by the company. Valid driver's license and good driving record required. Periodic travel required.

Physical Requirements

Lifting/Moving 0-20 lbs; Occasional (
Lifting/Moving 20-50 lbs; Occasional (
Ability to move over 50 lbs using lifting aide equipment; Occasional (
Driving; Often (20-50%)

Pushing/Pulling/moving objects, equipment with wheels; Occasional (
Manual Keying/Data Entry/inputting information/computer use; Occasional (
Climbing/accessing heights; Rarely

Nearest Major Market: Erie