OverviewThis role is eligible for either a hybrid work schedule at any Zenith office outside of California or otherwise can sit remotely. The Vice President, Medical Director serves as the clinical leader for the non-California offices and provides strategic oversight of medical management activities supporting workers' compensation claims operations in conjunction with the California Medical Director and other leaders. The role partners closely with Claims, Underwriting, Safety & Health, Legal, and Executive Leadership to improve the quality and cost of injured worker outcomes, manage medical severity, support evidence-based treatment decisions, and strengthen claim performance. Responsible for strategic clinical relationships with medical providers and facilities in order to drive quality, appropriate and necessary care for injured workers.
This position is heavily focused on occupational medicine and complex injury management, including catastrophic losses. The incumbent provides expert consultation on complex claims, emerging medical trends, treatment protocols, provider management strategies, and regulatory matters.
ResponsibilitiesClinical Leadership- Serve as a medical authority on occupational injuries and workers' compensation medical management.
- In conjunction with medical management peers, help establish and maintain evidence-based clinical guidance for treatment, recovery expectations, return-to-work planning, and disability duration management.
- Provide medical oversight and consultation on complex, severe, and catastrophic claims.
- Review and assess treatment plans, surgical recommendations, impairment ratings, causation questions, and medical necessity determinations.
- Support resolution of disputed medical issues and provide expert clinical opinions as needed.
Claims Management- Provide direct consultation on a variety of claims, including complex/catastrophic claims, occupational disease exposures, and fatalities.
- Attend claims staffings, roundtables and large loss review to provide medical perspective to claims management, discuss appropriateness of medical treatment and protocol, and provide prognosis to determine medical resources needed going forward.
- Partner with claims leadership to develop medical management strategies on high-severity losses.
- Evaluate long-term care projections, life care plans, Medicare Set-Asides, and future medical exposure estimates.
Medical Strategy and Outcomes- Develop clinical programs designed to improve recovery outcomes and reduce disability durations where clinically appropriate.
- Promote early intervention strategies that support safe and sustainable return-to-work outcomes.
- Analyze medical trends and treatment patterns to identify opportunities for improved outcomes and medical cost management.
- Provide recommendations regarding emerging treatment protocols, pharmaceuticals, medical technologies, and healthcare delivery models.
Provider Network and Vendor Oversight- Collaborate with utilization review, claims management, network management and bill review partners.
- Evaluate provider performance and treatment outcomes based on identified standards, metrics, and file review.
- Support development of occupational health, specialty physician, and catastrophic injury provider networks. Consult with network development in the identification, recruitment, contracting and credentialing and monitoring of providers.
- Serve as senior sponsor for strategic medical vendor relationships.
Leadership and Talent Development- Lead and develop certain members of the Medical Management team, to include clinical staff, medical consultants, and related professionals as applicable.
- Foster a culture of collaboration, innovation, accountability, and continuous improvement.
- Mentor claims and operational leaders on medical trends, catastrophic injury management, and clinical best practices.
Education- Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) required.
- Board Certification in Occupational Medicine strongly preferred.
- Additional certification in Physical Medicine & Rehabilitation, Emergency Medicine, Orthopedic Surgery, Neurology, Trauma Surgery, or related specialty considered advantageous.
Work Experience- Minimum 10 years of clinical experience, including at least 7 years focused on occupational injuries and workers' compensation.
- Significant experience managing catastrophic injuries and complex disability cases.
- Demonstrated leadership experience within an insurance carrier, managed care organization, healthcare system, TPA, or large self-insured employer.
Knowledge, Skills, and Abilities- Deep expertise in workers' compensation medical management, catastrophic injury treatment protocols, disability management, return-to-work strategies, impairment ratings, and life care planning.
- Ability to translate complex medical information into actionable business recommendations.
- Exceptional communication, influencing, analytical, and executive presentation skills.
- Ability to define problems, collect data, and draw valid conclusions.
- Excellent communication skills including the ability to read, analyze and interpret technical data, financial reports, and legal documents.
- Communicate effectively with a variety of customers including providers, members of the business community, clinical staff, and regulatory agencies.
Pay, Benefits, and Other InformationThe expected salary range for this position is $270,000 - $330,000. Actual pay will be adjusted based on experience, geographic location, and other job-related factors as permitted by law. Qualifications may warrant placement in a different job level.
Benefits- Medical, Dental and Vision Insurance
- Flexible Spending Accounts
- Paid Parental Leave
- Life, AD&D and Disability Insurance
- 401(k), Employee Share Purchase Plan (ESPP)
- Education and Training Reimbursement
- 10 paid Company Holidays, 2 Personal Days, 2 Floating Holidays
- Employee Assistance Program (EAP)
- For more information, review details on the Benefits page of our Career Site: https://www.thezenith.com/careers/benefits/
Zenith typically posts jobs for a minimum of 8 to 14 calendar days. If you are interested in any of our open positions, we encourage you to submit your application promptly.
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