Legal Staff Paralegal in Concord, CA

In-House

Concord, CA

Legal Staff Paralegal in Concord, CA

Legal Staff

No

Job Title: Senior Manager, Managed Care Regulatory Filings

Job Responsibilities:
- Execute and successfully complete managed care Utilization Review (UR) filings by state.
- Maintain standards for URAC accreditation and manage any onsite or virtual validation reviews or audits.
- Monitor the timeliness of UR determinations through daily and monthly reporting to ensure compliance with jurisdictional requirements.
- Conduct research on state Utilization Review regulations.
- Track and trend treatment services processed in UR.
- Serve as the liaison with regulatory and accrediting agencies for managed care UR filings.
- Oversee workflows to ensure processes meet all state regulations.
- Maintain and coordinate all filings, resubmissions, and UR data calls as necessary.
- Assist in the development and implementation of the Utilization Review program, which includes jurisdictional research, policies & procedures, workflows, vendor management, and UR correspondence.
- Collaborate with Claim Legal, Regulatory, and Compliance departments to respond to any UR complaints or questions from regulators.

Education and Experience Information:
- College degree with a major in Political Science, Economics, English, Nursing, or Philosophy.
- Previous experience in creating and submitting managed care and/or Utilization Review state filings is preferred.
- Moderate knowledge of Workers Compensation Utilization Review requirements by jurisdiction and accrediting bodies.
- Experience in maintaining URAC accreditation is preferred.
- Experience in quality assurance and audits.
- Experience in Paralegal research and submissions.

Skills & Knowledge:
- Utilization Review experience is required.
- Knowledge of workers' compensation laws and regulations.
- Excellent oral and written communication skills.
- Advanced computer skills, including proficiency in Microsoft Products.
- Advanced time management skills to maintain the state filing schedule for resubmissions.
- Ability to interact collaboratively and work effectively with a multi-functional team and throughout the organization.
- Strong organizational skills.
- Excellent interpersonal and negotiation skills.
- Ability to work in a team environment.
- Ability to meet or exceed performance competencies.
- Experience with state and external accreditation managed care audits and reviews.
- Ability to collaborate across functional lines and leaders.
- Strong communication skills.

Work Environment:
- Consideration for reasonable accommodations when applicable and appropriate.
- Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem-solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
- Physical: Computer keyboarding.
- Auditory/Visual: Hearing, vision, and talking.

Salary Information:
- A competitive compensation package is offered, along with excellent career advancement opportunities.
- Benefits include Medical & Dental Plans, Life Insurance (including eligible spouses & children), Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.

Company Culture:
- The company strives to create a diverse and inclusive culture where the thoughts and ideas of all employees are appreciated and respected. This includes differences in race, ethnicity, gender, sexual orientation, culture, religion, or disabilities.
- The company values excellence and recognizes that embracing diverse backgrounds, skills, and perspectives sustains a competitive advantage and maintains its status as an employer of choice.
- Diversity is considered a business imperative, enabling the attraction, retention, and development of the best talent available. It is an integral part of the company's identity, operations, and future vision.