This role is a key component of Sutter Health's THPM strategic plan. The THPM Workers’ Compensation program is expected to reduce absenteeism, enhance productivity, improve return to work results, reduce Workers' Compensation costs, increase employee morale and satisfaction, prevent on the job injury, decrease labor costs and decrease Workers’ Compensation / disability related litigation. The Director of Workers’ Compensation is responsible for leading the operations of Sutter Health’s self-insured, self-administered claims management program and developing and implementing cost reduction strategies and initiatives that align with and support those of the organization. The Director is also responsible to assure that staffing, culture, philosophies and processes are aligned with Sutter Health and Total Health and Productivity (THPM) key strategies and objectives. This individual manages, designs, organizes and leads a team of workers’ compensation and operations professionals to successfully meet Sutter Health and THPM key objectives.
Licensures and Certifications
A Certificate in Professional Disability Management is preferred
Driver License, Valid and in State required
Automobile Insurance required
Must have demonstrated skills and experience in management and administration of self-insured and commercially insured workers’ compensation programs in the health care industry, preferably in a multi-institutional integrated delivery system, is required.
Must be able to demonstrate good oral and written communication skills.
Must be able to analyze data and identify trends for staff and Affiliates.
Must have proven medical, disability, case management and litigation background.
Must have previous experience in working with brokers and carriers in the placement of coverage.
Prior experience with commercial insurance programs, including loss control is preferred.
Healthcare experience preferred.
Prior experience in developing partnerships with physician community desired.
Knowledge of California and Federal statutes and case law and the ability to analyze the impact on SH THPM.
Skills and Knowledge
Must be able ensure compliance with and recommend appropriate amendments to policies and procedures to maintain the department’s workers’ compensation state self-insurance certification to administer claims.
Must be knowledgeable in all aspects of disability law, legal procedures, and claims adjudication.
Demonstrated ability to manage multiple excess insurance policies and their reporting requirements.
Knowledge of workers’ compensation claim and IDM [is this integrated disability? Or a coding system?] systems, the Official Medical Fee Schedule, ICD-9 coding and medical terminology is required.
Knowledge of return to work programs for injured/ill employees with a transitional component that adheres to state and federal statutes.
Ability to provide input for development of a capital and operating budget for the Department is required.
Knowledge to develop and communicate cost benefit analyses is required.
Knowledge of statistics with the ability to develop accurate review and audit parameters is required.
Must be able to write and revise criteria based position descriptions and department policies and procedures.
Knowledge of interview techniques and protocols required.
Knowledge of evaluation procedures and performance reviews required.
Proven claims management skills are essential.
Demonstrated ability to handle confidential information is required.
Must be able to work independently, maintain a balance of work priorities and complete assignments within established timeframes.
Must have excellent analytical skills, the ability to draw valid conclusions and formulate sound recommendations is required.
Organizational and strategic planning skills are required
Ability to work with diverse health and administrative professionals at all organizational levels and demonstrated leadership skills required.
Demonstrated skills in PC applications (Microsoft Office) are required.
Internal Number: SHSO-1925844
About Sutter Health
Sutter Health has a long history in California. Some of our facilities have cared for their communities for more than 100 years. Today, our network of physician organizations, not-for-profit hospitals, outpatient centers, home health and other medical services cares for 3 million patients in more than 100 Northern California cities and towns. Every day, Sutter Health’s doctors, nurses, clinicians, employees and volunteers partner toward a single, shared purpose: providing high-value health care that’s personalized to patients’ needs.