Vice President, Bill Review and Managed Care

Vice President, Bill Review and Managed Care Join to apply for the Vice President, Bill Review and Managed Care role at Gallagher . Base pay range $142,500.00/yr - $278,000.00/yr Introduction At Gallagher, we help clients face risk with confidence because we believe that when businesses are protected, they’re free to grow, lead, and innovate. You’ll be backed by our digital ecosystem: a client‑centric suite of consulting tools making it easier for you to meet your clients where they want to be met. Advanced data and analytics provide a comprehensive overview of the risk landscape is at your fingertips. Here, you’re not just improving clients' risk profiles, you’re building trust. You’ll find a culture grounded in teamwork, guided by integrity, and fueled by a shared commitment to do the right thing. We value curiosity, celebrate new ideas, and empower you to take ownership of your career while making a meaningful impact for the businesses we serve. If you’re ready to bring your unique perspective to a place where your work truly matters; think of Gallagher. Overview Keenan is a leading insurance brokerage and consulting firm serving hospitals, public agencies and California school districts. Specializing in employee benefits, workers' compensation, loss control, financial services, and property & liability, Keenan is committed to delivering innovative solutions that protect and empower the communities we serve. As part of Gallagher, a global leader in insurance, risk management, and consulting, you’ll be joining a team that’s passionate about helping individuals and organizations thrive. The Vice President is responsible for the development, integration and operation of all aspects of our medical cost containment program. The essential functions of the position will be to differentiate the PRIME program in the marketplace; manage bill review and the nurse case managers including utilization review and case management functions. Ensure compliance of MPN with our business partner, design, develop and conduct training programs on medical case management; provide technical expertise to the case managers, and resolve complex procedural and medical issues. This is a remote position located in California. Must be willing to travel up to 25% throughout the state. How You’ll Make an Impact Manage Bill Review and Managed Care units. Review and report on monthly financials for case management and bill review. Management liaison with Enlyte / Genex, Harbor Health, One Call. Review of medical management impact reports to all managers and Account Executives. Maintain competitive intelligence on all PRIME fees. Develop pricing matrixes to determine revenue for PRIME. Complete analysis of fees based on information from competitive intelligence. Review pricing on an annual basis to determine if increases are needed, and provide analysis to the field with notification to the clients. Monitor copy service vendors/contracts and negotiate fees. Collaborate with vendor partners to improve programs. Assist with client proposals and workshops. Completion of request for proposals. Provide overview presentations to potential partner carriers/on‑site client visits. Assist Account Executives in program education/client interface. Coordinate bill review comparisons for new clients. Development of branding/differentiation and best practices. Initiate and develop innovative, quality alternatives to traditional treatment plans and patient care services. Review complex cases that are referred by case management or claims personnel to identify and resolve problems. Design, develop and conduct training programs. Ensure that all training manuals, Policy and Procedure Manuals and other departmental manuals used by clinical and non‑clinical staff are current. Keep current with medical technology and corresponding updates to medical practices and procedures. Other duties as assigned. About You Required: Bachelor's Degree with a minimum of 10 years experience in claims line of business. Minimum 5 years experience in claims management positions. Comprehensive knowledge of industry best practices and procedures. Active California RN license required. Preferred: 15+ years claims experience highly preferred. Relevant industry designations preferred. Behaviors: Demonstrated verbal and written communications skills, negotiation skills and influence management skills. Proven analytical and quantitative skills. Strategic thinker; able to make prompt, intelligent decisions based upon detailed analysis of complex issues. Strong service orientation to internal and external customers. Excellent interpersonal skills. Experience completing high impact projects effectively and efficiently. Able to multitask and work independently. Knowledge of Microsoft Office Suite tools. Experience with RMIS systems and data mining. Compensation and Benefits We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits. Minimum core benefits Medical/dental/vision plans, which start from day one! Life and accident insurance 401(k) and Roth options Tax‑advantaged accounts (HSA, FSA) Educational expense reimbursement Paid parental leave Other benefits include Digital mental health services (Talkspace) Flexible work hours (availability varies by office and job function) Training programs Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing Charitable matching gift program And more… The benefits summary above applies to full‑time positions. If you are not applying for a full‑time position, details about benefits will be provided during the selection process. We value inclusion and diversity Click Here to review our U.S. Eligibility Requirements Inclusion and diversity (I&D) is a core part of our business, and it’s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work. Gallagher embraces our employees’ diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest. Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non‑conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as “protected characteristics”) by applicable federal, state, or local laws. Equal employment opportunity will be extended in all aspects of the employer‑employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business. Seniority level: Not Applicable Employment type: Full-time Job function: Health Care Provider Industries: Insurance Referrals increase your chances of interviewing at Gallagher by 2x #J-18808-Ljbffr Gallagher