Director, Utilization Review

AmTrust Financial Services, a fast-growing commercial insurance company, has a need for a Director of Utilization Review in our Dallas, TX location.

The Director will lead the UR operation and own all responsibilities related to the management/oversight of the department and its employees. The Director will also focus on metrics/analytics to ensure that accurate data is being represented internally and externally.

Leads development and implementation of utilization review
• Researches, analyzes, develops and drives key initiatives for utilization review.
• Serve as a technical and business resource for utilization review and impairment rating review.
• Responsible for the execution and successful UR filing by state and URAC accreditation as needed.
• Participate in evaluating new and emerging technologies and treatments to determine possible incorporation into medical management program including evidence-based protocols and medical innovations
• Direct/provide enhancements to business processes, policies and infrastructure to improve operational efficiency as it relates to utilization review
• Serve as the liaison with regulatory and accrediting agencies for managed care UR filing
• Develop, implement and evaluate policies and procedures to meet business needs for utilization review and impairment rating review.
• Participate in the effective selection, coaching, medical education and clinical development of clinical review nurses.
• Manages project development/enhancements through coordination with WC operations
• Collaborates with MC Analytics team to provide analysis and reports of significant utilization trends, patterns, and impacts to resources.
• Collaborates with medical quality team to complete quality assurance reviews on various levels of utilization and external review reports.

• Licensed Registered Nurse
• Bachelor's degree, masters degree preferred
• Extensive knowledge of Workers Compensation Utilization Review requirements by jurisdiction and accrediting bodies
• Sound understanding of regulations associated with Utilization Review across all jurisdictions including state specific treatment guidelines
• Prior experience developing and leading clinical review nurses and clinical teams
• Knowledge of the following: pain management process and pharmaceuticals; behavioral health; drug rehabilitation process; WC laws and regulations
• Ability to prepare presentation documents and present to senior leadership
• Proven ability to manage organizational change, to involve and influence others to accept new ideas or innovative approaches, to lead in a team-based organization
• Ability to manage a diverse team including clinical professionals in multiple locations
• Ability to develop reports, metrics and improvement plans
• Ability to interact collaboratively and work effectively with a multi-functional team and throughout the organization; fosters an environment of shared responsibility and accountability
• Experience applying medical management treatment guidelines
• Experience with writing and implementing program level policy and procedures
• Experience with State and external accreditation managed care audits and reviews
• Demonstrated results in developing strategic plans and executing key initiatives
• Expertise in MS Office Suite including MS Outlook, MS Visio, MS Project, and MS PowerPoint and Excel

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AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.

AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.

AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.