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
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$/yr - $/yr

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.

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.

• 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.

• 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…