Workers Comp Clinical State Manager

The Workers’ Comp Clinical State Managerwill report to the Director of Workers’ Compensation and be a member of Ivy Health's Workers’ Comp Department Team. The successful candidate will support the development, maintenance, and management of Ivy Health's workers’ compensation program oversight specific state. 

This positionhas the opportunity to work remotely to candidates in based in EST/CST and will require some travel for business meetings.

Your responsibilities will include: 

• Perform responsibilities under general and direct supervision of Director of Workers’ Compensation Operations. 

• Perform assignments, tasks or activities that contribute to the overall workers’ compensation business objectives of the corporation and the business divisions being supported and formulating strategies to achieve those objectives. 

• Overseeing the implementation of those strategies. 

• Develop and maintain strong relationships with both external and internal customers to increase productivity with a focus on achieving claims handling excellence 

• Maintain proactive management of claims by focusing efforts toward expedient and equitable resolutions 

• Provide timely and appropriate direction and authority to assigned Third Party Administrators; establishing strong relations 

• Perform assignments, tasks or activities that contribute to the overall objectives of the business division being supported including but not limited to; claim investigations, settlements, and litigation 

• Work cross functionally in a team environment consisting of compliance, legal, IT, raintree support, front desk operations, revenue cycle, and finance. 

• Ensure all recovery opportunities are investigated and explored 

• Drive Workers’ Comp KPI Metrics, including but not limited to Workers’ Comp Visits, New Patients, LOS, SFQ, coding accuracy for PT/OT and Work conditioning payor mix, functional capacity evaluations, SSG planning, and other industrial specialty services.  

• Assist with workers’ compensation utilization review process management including but not limited to chart audit, peer review, bill review 

• Identify trends to determine business weaknesses and develop action plans to correct negative trends and establish monitoring method to ensure action plans have been successfully implemented 

• Responsible for implementation, monitoring and reporting on results of assigned special projects nurse case manager CEUs, social media blogs, workers’ comp networking/conference activities, and integration/companywide trainings.  

• Responsible for oversight of regional champions and working with regional directors to ensure we have the appropriate teammate. Provide ongoing mentoring and coaching opportunities to regional champions to optimize workers’ compensation business objectives. Facilitate oversight of biweekly agenda driven regional champion meetings. 

• Respond to workers’ comp distribution list to provide clinical support, clinical note audits, education, improve raintree efficiencies to field teammate support and communication. 

• Review documentation of new hires & integration partners to ensure best practice documentation and clean claims process is being promoted. 

• Provide clinical support and resolution for claims management to the organization. 

• Provide workers’ compensation quarterly in-services for clinical teammates. 

• Meet quarterly with RD, AD, RWCC, revenue cycle teammates, and business development teams to share results, highlight successes, and align with operational action plans to improve business objectives. 

• Work collaborative with business developmental team to assist with community and stakeholder networking events to market and brand workers’ comp service line. 

• Assist with integration and new hire clinical training for comprehensive clinical care program and documentation system. 

• Mentor regional champions for professional development on clinical ladders expert/advanced skills to expand clinical services offered in adult orthopedic offices. 

To excel in this role, you should possess: 

• Bachelor’s Degree or equivalent business experience 

• Clinical degree in Occupational Therapy or Physical Therapy 

• Minimum 5 years of experience in WC claims and/or legal experience; supervisory experience a plus 

• Willingness and ability to travel up to 25% of the time 

• Ownership/results/accountability-oriented, able to overcome obstacles 

• Ability to work in a fast-paced environment while maintaining a positive attitude 

• Self-motivated with the willingness and commitment to exceed expectations, learn and professionally grow 

• Exceptional written and verbal communication, presentation, and interpersonal skills 

• Outstanding time management skills and ability to manage multiple tasks and assignments in a changing environment with competing projects 

• Ability to maintain strict confidentiality 

Why choose Ivy Health?    

• Exceeding Expectations: Deliver best-in-class care and witness exceptional patient outcomes.    

• Incentives Galore: Eligibility for full benefits package beginning within your first month of employment. Generous PTO (Paid Time Off) plans and paid holidays. 

• Empowering Values: Live by values that prioritize teamwork, growth, and serving others.   

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