AVP, Utilization Review & Pharmacy

Zurich Insurance is seeking an AVP, Utilization Review & Pharmacy. This is a fully remote position, offering the flexibility of a home-based office.

As the AVP of Utilization Review & Pharmacy, you will lead and direct a team of Utilization Review and Pharmacy nurses who are responsible for the review of clinical services for the determination of medical necessity and appropriateness of care of our insureds’ injured employees. You will develop, recommend and execute short- and long-term strategies that enable utilization review and pharmacy to achieve profitability goals and ensure the delivery of quality, cost effective services to our Managed Care stakeholders. You will act as a subject matter expert and technical resource to Managed Care stakeholders regarding operational and regulatory cost containment issues. This position has clear and distinct accountability for business results and works with Managed Care and Claims leadership to create and align utilization and pharmacy cost containment strategies with our customers’ need. This role also involves managing and overseeing team activities, and being responsible for the performance, development, and coaching of staff to maximize contributions and drive employee growth and improvement.

Key Responsibilities:

• Provide oversight and accountability for the utilization review and pharmacy operations by ensuring the delivery of high quality and cost effective services
• Participate in the development and implementation of a strategic plan for the utilization review and pharmacy functions by evaluating and improving the efficiency of business processes and best practices to enhance customer service, technical excellence quality and employee engagement.
• Drive technical excellence by determining and managing key performance metrics associated with utilization review and pharmacy
• Respond to escalated customer and regulatory inquiries accurately and in a professional manner by researching issues, determining root causes and implementing solutions.
• Develop and implement process improvement ideas to improve efficiency of functional area.
• Provide oversight and accountability for UR and pharmacy operation’s culture of continuous improvement of the clinical expertise across the organization.
• Motivate and lead a high performance team by attracting, onboarding, recruiting and retaining team members.
• Drive the performance management process by communicating job expectations, monitoring and evaluating performance, providing feedback and facilitating employee development.

Basic Qualifications:

• Bachelors Degree and 7 or more years of experience in the Nursing area
  AND
• Registered Professional Nurse license in residential area and in operational national/local areas as mandated by jurisdictions
• 5 or more years of clinical experience in medical/surgical, orthopedic neurosurgical, psychiatric nursing, or rehab field
• Experience in development and implementation of cost containment programs
• Case management, utilization review, catastrophic or disability experience
• 5 or more years of management experience
• Experience in outcome measurements to determine effectiveness of the programs
• Experience in servicing customers
• CDMS
• CCM
• CRRN
• COHN
• CRS
   

Preferred Qualifications:

• People and performance management experience
• Experience in outcome measurements to determine the effectiveness of programs
• Thorough understanding of the workers’ compensation claims process, including regulatory compliance, documentation, and coordination with stakeholders
• Strong leadership experience
• Strong verbal and written communication experience
• Strong organization skills
• Analytical and problem-solving skills
• In-depth knowledge of the insurance industry, claims and the insurance legal and regulatory environment
• Customer service experience
• Proficiency with Microsoft Office
• Ability to travel 0%-25%

At Zurich, compensation for roles is influenced by a variety of factors, including but not limited to the specific office location, role, skill set, and level of experience. In compliance with local laws, Zurich commits to providing a fair and reasonable compensation range for each role. For more information about our Total Rewards, please click here. Additional rewards may encompass short-term incentive bonuses and merit increases. We encourage candidates with salary expectations beyond the provided range to apply as they will be considered based on their experience, skills, and education. The compensation indicated represents a nationwide market range and has not been adjusted for geographic differentials pertaining to the location where the position may be filled. The proposed salary range for this position is $113,100.00 - $185,100.00, with short-term incentive bonus eligibility set at 20%.

As an insurance company, Zurich is subject to 18 U.S. Code § 1033. 
 

A future with Zurich. What can go right when you apply at Zurich?

Now is the time to move forward and make a difference. At Zurich, we want you to share your unique perspectives, experiences and ideas so we can grow and drive sustainable change together. As part of a leading global organization, Zurich North America has over 150 years of experience managing risk and supporting resilience. Today, Zurich North America is a leading provider of commercial property-casualty insurance solutions and a wide range of risk management products and services for businesses and individuals. We serve more than 25 industries, from agriculture to technology, and we insure 90% of the Fortune 500®. Our growth strategy is not limited to our business. As an employer, we strive to provide ongoing career development opportunities, and we foster an environment where voices are diverse, behaviors are inclusive, actions drive equity, and our people feel a sense of belonging. Be a part of the next evolution of the insurance industry. Join us in building a brighter future for our colleagues, our customers and the communities we serve. Zurich maintains a comprehensive employee benefits package for employees as well as eligible dependents and competitive compensation. Please click here to learn more.

Zurich in North America is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. 

Zurich does not accept unsolicited resumes from search firms or employment agencies. Any unsolicited resume will become the property of Zurich American Insurance. If you are a preferred vendor, please use our Recruiting Agency Portal for resume submission. 

Location(s): AM - Schaumburg, AM - Remote Work (US)
Remote Working: Hybrid
Schedule: Full Time
Employment Sponsorship Offered: No 
 
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