Director Medical Management Nursing Services Worcester, MA, USA ● Virtual Req #18714 Monday, March 24, 2025
For more than 170 years, The Hanover has been committed to delivering on our promises and being there when it matters the most. We live our values every day, demonstrating we CARE through our values, ESG initiatives and IDE journey.
Our Claims team is seeking a Director of Medical Management Nursing Services. This is a full time, exempt role. This is a remote or hybrid opportunity out of the Worcester, MA office.
POSITION OVERVIEW:
Responsible for the strategic oversight and countrywide management of claims clinical nursing products and services and managing and leading Medical Managers and their employees within Medical Strategy, supporting all injury lines of business. Delivers effective leadership, technical and clinical direction, performance management, communication, relationship building, decision making, and customer service. Develops and drives execution of our strategic initiatives and our most important processes to deliver high quality service and results. Ensures related nursing products and services are developed, supported, and managed by evidence-based medical treatment guidelines. Expertly seeks nursing and product improvement and innovation to address clinical issues that directly impact claim outcomes and customer experience. Potential to manage strategic external vendor partnership and programs to ensure compliance with Service Level Agreements. Participates in special projects and assignments. Responsible for assessing the present and future resource needs for employees and providing the leadership, mentoring and guidance necessary to build and sustain a high performing workforce.
IN THIS ROLE, YOU WILL:
* Develop and execute key strategic initiatives and operational processes to drive improved results.
* Management and oversight of processes/initiatives to ensure cost effective operations.
* Ensure high quality standards in nurse claims work product are met by adherence to guiding principles.
* Provide analysis through key metrics to measure and ensure initiatives are successful.
* Provide innovative solutions to improve our nurse claim outcomes, processes, and protocols.
* Ongoing activities associated with work product quality.
* Accountable for monitoring performance through various identified methods, provide feedback and coaching and take appropriate action.
* Solicit and act on internal customer feedback on escalated claims.
* Develop, recommend, and authorize implementation of continuous improvement initiatives which may result in cost effective enhancements in quality and service.
* Identify key issues and communicate to the proper audience in an appropriate and timely manner.
* Act as an expert resource for direct reports, other teams, business units and claims leadership.
* Lead and/or participate in initiatives that support claims strategies and financial goals.
* Interact effectively with the SLT and act as a backfill for AVP as needed. Talent/Performance Management.
* Monitors volume and business plans, utilizes technology and talent management to increase efficiency and scalability to support business needs.
* Makes timely staffing recommendations within established models and participates in identifying the ideal candidate.
* Identify and provide developmental opportunities through coaching and mentoring and builds succession plans.
* Recognizes opportunities for technical and industry training as part of a personal and professional development program.
* Sets cascading goals, gives, and receives feedback, documents, and delivers performance reviews, makes salary recommendations, addresses performance issues, creates, and implements development plans while conforming to policies and other internal procedures.
* For assigned vendor products, manages vendor performance against established service level agreements and key performance metrics, resolves issues and identified product gaps.
* Supports clinical educational needs of the field through collaboration with L&D on nursing products and services, medical knowledge, and clinical/evidence-based medical guidelines, where appropriate.
* Works collaboratively with Product Managers, Line of Business leaders.
* Oversees Medical Director consultation services to ensure proper utilization, quality, and costs.
WHAT YOU NEED TO APPLY:
* Registered Nurse with 8+ years of clinical experience in acute or ambulatory healthcare setting, with related claims experience.
* Juris Doctor degree or commensurate legal experience or MBA preferred.
* Proven track record leading and managing others.
* Possess strong business acumen and advanced claims technical knowledge.
* Anticipates needs of the customer and takes a proactive approach to ensure they are met.
* Effectively and creatively utilizes all resources (systems, people, etc.) to manage daily operations.
* Flexible and able to change priorities as business needs arise.
* Ability to multi-task and prioritize.
* Teaching and coaching style of management. Serves as a role model in building effective relationships.
* Understands and articulates claims operations in a way that drives and achieves results.
* Analytical and problem-solving skills are essential; anticipates issues, seeks out and analyzes information collaboratively to propose solutions. Takes ownership for a successful resolution.
* Exhibits key attributes of Dynamic Leadership.
* Viewed as a change agent.
* Applies innovative thought process to solve problems and to improve outcomes.
* Leader amongst his or her peer group and can show examples of followership.
* Skilled in data analytics and the ability to switch from tactical to strategic.
* Effectively and diplomatically communicates with a wide-ranging audience from senior leadership to frontline adjusters/nurses.
* Ability to listen so the needs of the speaker can be accurately ascertained.
* Genuinely collaborates with a wide spectrum of individuals from senior leaders, internal business customers, agent partners to the frontline adjusting/nursing staff.
* Builds and fosters relationships with a focus on partnering.
* Influences peers to act despite having no direct authority over them.
* Filters and synthesize feedback provided.
* Proficient in the Office 360 suite, including the use of PowerPoint for presentation purposes.
CAREER DEVELOPMENT:
It’s not just a job, it’s a career, and we are here to support you every step of the way. We want you to be successful and fulfilled. Through on-the-job experiences, personalized coaching and our robust learning and development programs, we encourage you – at every level – to grow and develop.
BENEFITS:
We offer comprehensive benefits to help you be healthy, build financial security, and balance work and home life. At The Hanover, you’ll enjoy what you do and have the support you need to succeed.
Benefits include:
* Medical, dental, vision, life, and disability insurance
* 401K with a company match
* Tuition reimbursement
* PTO
* Company paid holidays
* Flexible work arrangements
* Cultural Awareness Day in support of IDE
* On-site medical/wellness center (Worcester only)
* Click here for the full list of Benefits
EEO statement:
The Hanover values diversity in the workplace and among our customers. The company provides equal opportunity for employment and promotion to all qualified employees and applicants on the basis of experience, training, education, and ability to do the available work without regard to race, religion, color, age, sex/gender, sexual orientation, national origin, gender identity, disability, marital status, veteran status, genetic information, ancestry or any other status protected by law.
Furthermore, The Hanover Insurance Group is committed to providing an equal opportunity workplace that is free of discrimination and harassment based on national origin, race, color, religion, gender, ancestry, age, sexual orientation, gender identity, disability, marital status, veteran status, genetic information or any other status protected by law.
As an equal opportunity employer, Hanover does not discriminate against qualified individuals with disabilities. Individuals with disabilities who wish to request a reasonable accommodation to participate in the job application or interview process, or to perform essential job functions, should contact us at: HRServices@hanover.com and include the link of the job posting in which you are interested.
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Other details
* Pay Type Salary
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