Regional Claims Manager jobs in Pierre, SD

Regional Claims Manager manages the operations of an insurance claims department to meet operational, financial, and service requirements. Oversees the intake and processing of insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Being a Regional Claims Manager manages appraisal and examination staff and processes. Assures timely and proper disposition of claims based on policy provisions. Additionally, Regional Claims Manager recommends and implements best practices to ensure complete and thorough claim settlements, legal reviews, and investigations following company policies and insurance industry regulations. Determines the value of settlements for escalated claims. Manages negotiations of settlements and administration of claims in litigation. Typically requires a bachelor's degree. Typically reports to top management. The Regional Claims Manager typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. To be a Regional Claims Manager typically requires 3+ years of managerial experience. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. (Copyright 2024 Salary.com)

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Retail Pharmacy Manager
  • Winner Regional Healthcare Center
  • Winner, SD FULL_TIME
  • Description:

    Position Summary:

    The Retail Pharmacy Manager is responsible for the coordination of clinical services, medication use evaluation, adverse drug reactions, reporting program and staff development program. Provides age appropriate pharmaceutical care and patient information to the neonatal, pediatric, adolescent, adult and geriatric customers of Winner Regional Health. Provides pharmaceutical care by following established standards and practices consistent with hospital policy and professional practice standards as well as state and federal law. Works within the dictates of hospital administration and the hospital medical staff.

    The Retail Pharmacy Manager reviews, interprets and dispenses both prescription and non-prescription medication to patients. The Retail Pharmacy Manager takes an active role in responding to prescription issues and advising providers on the selection, dosage, interaction and side effects of medications. Counsel patients on the medication prescription including but not limited to: proper administration, possible side effects, expected response, storage and any other questions posed by the patient. Monitors the health and progress of patients in response to drug therapy. Must be able to learn and utilize new technology as the profession of pharmacy evolves.

    The Retail Pharmacy Manager reviews and interprets provider orders, provides drug information, assists in problem solving, and provides other aspects of pharmaceutical care. Duties may consist of unit dose dispensing, IV Admixtures, outpatient prescriptions, navigating the electronic medical record, compounding, and working with automated dispensing devices. The Retail Pharmacy Manager utilizes appropriate age – related patient information to assess the pharmaceutical needs of patients, which may include provision of pharmaceutical care to neonatal, pediatric, adolescent, adult and geriatric patients. The pharmacist follows all established regulations and standards that govern the practice of pharmacy. Demonstrates good written and verbal communication skills. Must be able to learn and utilize new technology as the profession of pharmacy evolves. Provides oversite and clinical supervisor for pharmacy services and pharmacy support personnel.

    Pharmacy services at Winner Family Drug may include involvement in acute care surgery, neurology, cardiology, pediatrics, oncology, infusion services, intensive care, general medicine, dialysis, transplant, antimicrobial stewardship, and medication reconciliation. May include decentralized clinical functions, such as direct patient interaction/Interdisciplinary team rounding, chart reviews, customer or patient counseling, collecting accurate medication list. May also include centralized clinical functions, such as checking and dispensing medications and overseeing the clinical functions of the IV room.

    When students are providing patient care, treatment, and/or services as a part of their training, any/all employees may be asked to supervise the students.

    Other duties as assigned.

    Requirements:

    Education/Experience:

    Graduate from an accredited school of pharmacy.


    Required Credentials (Licensure, Certification, or Registration):

    Must have current license to practice pharmacy in the State of South Dakota.

    Employment Variables:

    Retail Pharmacy hours are 8:30AM to 6:00PM Monday thru Friday and 8:00AM to 12:00PM on Saturday.

    Hours worked will depend upon work status of employee and workload requirements.

    Initial Tuberculosis (TB) test and drug screening is required by Winner Regional Health. Rubella titer will also be drawn upon hire and immunization is required if no past exposure or indication of immunization. Required to wear name tag provided by WRH and to follow the dress code of WRH.

    Job Knowledge and Skills:

    Ability to read, write, speak and understand the English language. Excellent oral and written communication skills.

    Ability to deal with people in a professional manner. Problem solve effectively. Able to demonstrate technical and clinical competency and expertise in pharmacy practice and able to follow policies and procedures. Supervision and leadership experience.

    Direct Supervisor:

    Chief Executive Officer

    PART II: CODE OF CONDUCT

    Honesty We will do the right thing at all times, even if it is difficult, maintaining strong, ethical practices. We protect the confidentiality of others, including patients, staff and the facility as a whole. We will take responsibility for our actions.

    Expertise We will demonstrate superior judgment, training and skill, at all times, demonstrating professionalism while doing so. We will perform all aspects of our job to the best of our ability, utilizing all resources and tools available.

    Approachability We will be non-judgmental, friendly, and open and willing to listen to everyone we come into contact with while performing our duties. We are humble and learn from others.

    Respect We will be understanding and sensitive to others’ feelings; caring and responding in a manner that sets them at ease, keeping the situation in perspective without minimizing others’ feelings or reactions. We will listen to others with full attention in a sincere, civil fashion, being careful not to be judgmental of the speaker. We maintain composure when facing conflict and avoid jumping to conclusions and defaming another’s name.

    Teamwork We willingly work together with a common approach, trusting and supporting members of our organization, using our skills and resources, sharing information to achieve a common aim.

    PART III: STANDARDS OF CONDUCT FOR LEADERS

    Accountability

    • Build meaningful teams and promote staff involvement.
    • Respond to employee and/or customer concerns in a timely manner.
    • Leaders or designee will be available during business hours Monday thru Friday.
    • Develop and manage department budget including revenue, expense, and staffing.
    • Attend and participate in continuing education, meetings, and seminars.

    Communication

    • Develop and maintain effective communication.
    • Communication at all levels.
    • Notify the switchboard, your department, Administration, and Directors of scheduled absences.

    Integrity

    • Make an effort to know the Directors and facility employees.
    • Abide by and support employees in Winner Regional Health Standards of Conduct for Employees.
    • Treat all employees with respect and fairness.

    Mentor-Empower

    • Motivate and develop employees.
    • Reward and recognize employees with good judgement.
    • Create an environment where all employees are valued and empowered to participate in solutions.
    • Visibility of leadership during all shifts.

    Organizational Understanding/Integration

    • Link and coordinate with other departments/entities, works across boundaries, and builds mutually beneficial partnerships and networks.

    PART IV: ESSENTIAL FUNCTIONS

    Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Following are the essential functions of the job, along with the corresponding performance standards.

    FUNCTION

    Supervision and Support

    • Review and update Departmental policies as needed.
    • Develop new Departmental policies that are understandable, accurate, and concise.
    • Develop and maintain positive customer relations.
    • Work with pharmacy staff to maintain and implement all regulatory standards (CMS, Board of Pharmacy, etc.).
    • Accurately and completely document employee’s performance.
    • Complete special projects with minimal supervision in a timely manner.
    • Effectively supervise staff (both clinical and non-clinical) for optimal department performance.
    • Provide feedback to personnel on an ongoing basis.
    • Function as a competent resource to staff and directors in the provision of pharmaceutical care.
    • Manage time through prioritization, setting and meeting realistic deadlines.

    Medical Staff Involvement

    • Represent the Department of Pharmaceutical Services on Medical Staff Committees, Hospital Committees, and Task forces.
    • Support staff by responding to drug information and drug therapy monitoring requests and consultations in a timely manner.

    Maintain a Knowledge of Therapeutics

    • Participate in drug therapy education of pharmacy staff, students, and pharmacy residents.
    • Maintain and continually upgrade skills as a pharmacy manager.
    • Maintain current knowledge of FDA approved drugs and indications.

    Strategic Focus

    • Must focus work closely within the department and facility to accomplish WRH strategic priorities.
    • Must be active in strategic planning within the department and facility to stay up with current trends in healthcare.
    • Demonstrate vision and creativity when participating in strategic and long range planning of WRH.

    PART V: COMPLIANCE

    Compliance Must comply with the Corporate Compliance Policy and all laws, rules, regulations and standards of conduct relating to the position. The employee has a duty to report any suspected violations of the law or the standards of conduct to the Compliance Officer or the Chief Executive Officer.

    PART VI: PHYSICAL AND MENTAL REQUIREMENTS

    General Activity

    In a regular workday, employee may:

    • Sit 3 Hours at a time; up to 4
    • Hours during the day
    • Stand 3
    • Hours at a time; up to 6 Hours during the day
    • Walk .25 Hours at a time; up to 2
    • Hours during the day

    Motion

    Employee is required: (In terms of a regular workday, "Occasionally" equals 1% to 33%, "Frequently" 34% to 66%, "Continuously", greater than 67%.)

    • Bend/Stoop Occasionally Kneel, Duration 30 sec Occasionally
    • Squat Occasionally
    • Balance Occasionally
    • Crawl, Distance Not at all
    • Twist Occasionally
    • Climb, Height Occasionally
    • Keyboarding/Mousing Occasionally
    • Reach above shoulder level Occasionally

    Physical Demand

    Employee’s job requires he/she carry and lift loads from the floor, from 12 inches from the floor, to shoulder height and overhead. Employee’s job requires a pushing/pulling force to move a load (not the weight of the load).

    Physical Demand Classification: Carrying/lifting weight and pushing/pulling force:

    • Light Occasionally 20 lbs.
    • Frequently 10 lbs.
    • Constantly Negligible

    Sensory Requirements:

    • Yes/No Explanation (if Yes)
    • Speech Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.
    • Yes
    • Communicates with patients, family members, physicians, co-workers, and other health care staff is essential.
    • Vision (VDT) Are there specific vision requirements for the job?
    • Yes
    • High degree of eye-hand coordination is essential to the operation and use of pharmaceutical equipment.
    • Hearing Ability to receive detailed information through oral communications, and to make fine discriminations in sound; i.e., making fine adjustments on machine parts, using a telephone, taking blood pressures.
    • Yes
    • Vital for communication with other clinic staff and patients directly or via telephone.

    Environmental Factors

    Yes/No Explanation (if Yes)

    • Working on unprotected heights No
    • Being around moving machinery No
    • Exposure to marked changes in temperature and humidity No
    • Driving automotive equipment Yes Occasional meeting out of building
    • Wearing personal protective equipment Yes Chemo precautions, code/Trauma situations
    • Exposure to atmospheric conditions (i.e. fumes, dust, odors, mists, gases, or poor ventilation) Yes
    • Alcohol
    • Exposure to extreme noise or vibration No
    • Exposure to blood, body fluids and waste Yes Code/Trauma situations, cart exchange, emergency kits
    • Exposure to radiation No
    • Exposure to other hazards (i.e. mechanical, electrical, burns, or explosives) Yes
    • Chemicals, chemotherapy

    Emotional/Psychological Factors

    Yes/No Explanation (if Yes)

    • Stress: Exposed to stressful situations Yes
    • Occasional high work load volumes. Assist in frequent problem solving and occasional conflict resolution.
    • Concentration: Must be able to concentrate on work tasks amidst distractions. Yes
    • Constant distractions from telephone calls from patients, physician, health care professionals, and other pharmacy interruptions from pharmacy personnel.
    • Must exert self-control. Yes
    • Must retain composure under stressful situations. Must maintain good working relationships with co-workers.

    PART VII: JOB RELATIONSHIPS

    Supervises

    0 No supervisory responsibilities

    1 Supervisory responsibility

    # Direct Reports: 7

    # Indirect Reports:

    Age of Patient Populations Served

    • 0 Neonates: 1-30 days
    • 0 Infant: 30 days - 1 yr
    • 0 Children: 1- 12 yrs
    • 0 Adolescents: 13- 18 yrs
    • 0 Adults: 19- 70 yrs
    • 0 Geriatrics: 70 yrs
    • 1 All
    • 0 Not applicable

    Internal Contacts

    • 1 Patients
    • 1 Providers: (i.e. Physicians, Therapists, Social Workers)
    • 1 Staff: (i.e. clinical and administrative support staff)
    • 1 Volunteers
    • 0 Others:

    External Contacts

    • 1 Patients
    • 1 Families/Significant Others
    • 1 Providers
    • 1 Vendors
    • 1 Community and Health Agencies
    • 1 Regulatory agencies
    • 1 Other: Job Applicants
  • 8 Days Ago

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Independent Insurance Claims Adjuster in Aberdeen, South Dakota
  • MileHigh Adjusters Houston Inc
  • Aberdeen, SD FULL_TIME
  • ADJUSTERS NEEDED NOW FOR ALL STORM RELATED SEASONS!Independent Insurance Claims Adjusters Needed Now! This is a HUGE opportunity for you, since there is currently a HIGH DEMAND forNEW ADJUSTERS AND NE...
  • 1 Month Ago

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Independent Insurance Claims Adjuster in Pierre, South Dakota
  • MileHigh Adjusters Houston Inc
  • Pierre, SD FULL_TIME
  • ADJUSTERS NEEDED NOW FOR ALL STORM RELATED SEASONS!Independent Insurance Claims Adjusters Needed Now! This is a HUGE opportunity for you, since there is currently a HIGH DEMAND forNEW ADJUSTERS AND NE...
  • 1 Month Ago

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Clinic Nurse / Certified Medical Assistant
  • Mobridge Regional Hospital
  • Mobridge, SD FULL_TIME
  • Home » Employment » Job Openings » Job Openings var taoSubDir=''; var taoCal = new Calendar(""); Clinic Nurse / Certified Medical Assistant05/10/2016West Dakota Health Center - Timberlake currently ha...
  • 19 Days Ago

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Human Resource Generalist
  • Winner Regional Health Center
  • Winner, SD FULL_TIME
  • Human Resource Generalist Full-time position. Monday to Friday. 8am-5pm, some travel may be required. Will provide a broad range of day-to-day human resource functions such as: recruitment, on-boardin...
  • 21 Days Ago

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MDS Coordinator – Long Term Care
  • Winner Regional Health Center
  • Winner, SD FULL_TIME
  • MDS Coordinator – Long Term Care Full-time position available in LTC. Day shift – On call every 3rd weekend. This is not a remote position. The ideal candidate will possess at least 1 year experience ...
  • 21 Days Ago

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0 Regional Claims Manager jobs found in Pierre, SD area

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Pharmacist
  • Department Of Health And Human Services
  • Fort Thompson, SD
  • Summary These positions will be located within the Great Plains Area - Indian Health Service. This position reports to t...
  • 3/28/2024 12:00:00 AM

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Clinical Laboratory Scientist
  • Department Of Health And Human Services
  • Fort Thompson, SD
  • Summary This position serves as a Clinical Laboratory Scientist at one of the various Hospitals or Clinics in the Great ...
  • 3/28/2024 12:00:00 AM

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Financial Representative
  • Modern Woodmen of America
  • Pierre, SD
  • The ideal candidate will deliver personalized investment solutions to help clients work toward their long-term financial...
  • 3/28/2024 12:00:00 AM

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Financial Advisor
  • Prudential Financial
  • Pierre, SD
  • Prudential Advisors is looking for an experienced financial professional in the Pierre area that is interested in workin...
  • 3/28/2024 12:00:00 AM

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Transportation Security Officer
  • Transportation Security Administration
  • Pierre, SD
  • Summary Transportation Security Officers are responsible for providing security and protection of travelers across all t...
  • 3/27/2024 12:00:00 AM

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Diagnostic Radiologic Technologist
  • Department Of Health And Human Services
  • Lower Brule, SD
  • Summary This position is located in the Radiology Department at one of the various IHS facilities located in the Great P...
  • 3/27/2024 12:00:00 AM

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Insurance Audit Senior - Louisville, KY / Jeffersonville, IN (Hybrid or Remote)
  • Cherry Bekaert
  • Pierre, SD
  • **Description** **Cherry Bekaerts** Audit and Assurance practice has been growing. Come be a part of the growth as an **...
  • 3/26/2024 12:00:00 AM

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Licensed Property & Casualty Insurance Agent (Remote) – (English or Bilingual Spanish)
  • Concentrix
  • Pierre, SD
  • Job Title: Licensed Property & Casualty Insurance Agent (Remote) (English or Bilingual Spanish) Job Description ****Must...
  • 3/25/2024 12:00:00 AM

Pierre (/pɪər/; Lakota: čhúŋkaške, "fort") is the capital of the U.S. state of South Dakota and the seat of Hughes County. The population was 13,646 at the 2010 census, making it the second-least populous state capital in the United States, following only Montpelier, Vermont, and the eighth-most populous city in South Dakota. Founded in 1880 on the east bank of the Missouri River opposite Fort Pierre, Pierre has been the state capital since South Dakota gained statehood on November 2, 1889. It was challenged by Huron for the capital and won because of its location in the geographic center of t...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Regional Claims Manager jobs
$134,622 to $188,529
Pierre, South Dakota area prices
were up 0.8% from a year ago

Regional Claims Manager in Tucson, AZ
As a Regional Contract Claims Manager, located in our Broomfield, CO office, you will have responsibility for claims management within your assigned region.
December 13, 2019
Regional Claims Manager in Las Cruces, NM
Paul Martin of Colorado seek an unspecified amount of damages against defendants Shelly Reams, former administrator of the Wyoming Aeronautics Commission; members of the Cheyenne Regional Airport Board; Dave Haring, manager of the Cheyenne airport; and Great Lakes Aviation.
February 18, 2020
Regional Claims Manager in Passaic, NJ
Aligning performance of regional teams, to support delivery of the wider Third-Party Claims Targets & Objectives.
January 16, 2020