Director, Managed Care Services and Vendor Management
On-site · Portland, Maine, United States
Job Summary
Directs medical management programs within MEMIC, overseeing internal clinical teams and external medical management vendors to drive cost containment, improve return-to-work outcomes, and ensure compliance with jurisdictional workers’ compensation regulations. Leads vendor strategy and performance, develops workflows integrating medical management into claims processes, and collaborates with Claims leadership to align interventions with the claim lifecycle. Responsible for managing the department budget, administering SLAs/KPIs, conducting vendor scorecards and audits, and fostering cross-team collaboration to optimize claim outcomes and reduce cost per claim. Requires strong clinical knowledge, analytical/financial skills, and experience managing multi-state medical vendor relationships.
Required Qualifications
- Five or more years of progressive experience in Workers’ Compensation Medical Management, claims operations, or medical vendor oversight
- Three plus years of previous management experience
- Deep knowledge of Workers Compensation medical delivery models, utilization controls, and regulatory environments
- Clinical background (RN, CCM) or extensive experience partnering with clinical teams
- Experience supporting claims or medical transformation initiatives
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