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Great American Insurance GroupPosted 10/20/2026full-timeWoodland Hills • California • United StatesSenior💰 $135,000 - $183,000 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates advanced knowledge of workers’ compensation clinical practices, including California MTUS, ODG Guidelines, and Utilization Review, while effectively managing complex cases and leading staff in a healthcare management environment.
Highest-signal resume keywords
Workers’ Compensation Clinical PracticesUtilization Review ComplianceProvider and Vendor ManagementLeadership and Staff DevelopmentNegotiation and Cost Containment
About the role
Key responsibilities & impact- Lead and oversee managed care activities to ensure injured workers receive appropriate, effective, timely, and cost-efficient medical treatment
- Provide clinical expertise on complex and catastrophic workers’ compensation claims
- Apply California MTUS, ODG Guidelines, California formulary requirements, and applicable workers’ compensation medical treatment regulations
- Review complex treatment plans, care facilities, and medical-cost projections
- Guide staff in evaluating treatment requests and support Utilization Review compliance
- Oversee Nurse Case Management activities, including clinical direction, documentation, follow-up, reporting, and caseload prioritization
- Manage relationships with healthcare providers and medical vendors
- Negotiate with providers and rehabilitation facilities and identify cost-effective treatment alternatives
- Evaluate causation and body-part allegations to support claims handling
- Collaborate with claimants, claims professionals, healthcare providers, vendors, and cross-functional teams
- Monitor medical expenses and treatment utilization for responsible cost management
- Lead, coach, and develop staff; establish priorities, allocate resources, manage performance, and support talent decisions
- Monitor managed care laws, regulations, legislation, medical trends, treatment strategies, and industry standards
- Participate in annual planning and goal setting and implement policies, procedures, and strategies
Requirements
What you’ll need- Bachelor’s degree in Healthcare Management, Nursing, or a related field required
- Registered Nurse (R.N.) licensure preferred
- Minimum of 14 years of case-management or managed-care experience
- At least 6 years of leadership experience
- Advanced knowledge of workers’ compensation clinical practices, including California MTUS, ODG Guidelines, formulary requirements, Utilization Review, and applicable medical treatment regulations
- Experience managing complex or catastrophic cases, evaluating treatment plans, and providing clinical guidance to claims professionals and case-management staff
- Experience with provider and vendor management, medical-cost containment, treatment negotiations, CPT coding, durable medical equipment, rehabilitation services, and related contractual arrangements
- People-leadership experience, including coaching and developing staff, prioritizing caseloads, allocating resources, managing performance, and leading two or more direct reports
- Strong clinical judgment, communication, negotiation, collaboration, and problem-solving skills
- Must be authorized to work in the United States without the need for current or future sponsorship
Benefits
Comp & perks- Medical coverage
- Dental coverage
- Vision coverage
- Wellness plans
- Parental leave
- Adoption assistance
- Tuition reimbursement
- Paid Time Off
- Paid holidays
- 401(k) plan with company match
- Employee stock purchase plan
- Commuter benefits
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Case ManagementClinical ExpertiseCPT CodingMedical Treatment RegulationsTreatment Plan EvaluationCost ManagementDurable Medical EquipmentRehabilitation ServicesMedical-Cost ContainmentCalifornia Formulary Requirements
Soft Skills
Strong Clinical JudgmentCommunicationCollaborationProblem-SolvingNegotiation
Certifications & Qualifications
Registered Nurse (R.N.) Licensure
Industry Keywords
Managed CareHealthcare ManagementWorkers’ CompensationMedical Treatment RegulationsCalifornia MTUSODG GuidelinesTreatment StrategiesManaged Care LawsClinical DirectionCaseload Prioritization