Responsibilities:
- Review of health plan data and develop clinical findings and projections of future spend.
- Use of clinical knowledge to work with health insurance carriers to ensure appropriate clinical care coordination.
- Work with client to develop an appropriate a health risk management plan.
- Work closely with our Account Management Team to develop a cohesive plan to control costs within the health plan.
- Assist members in identifying participating providers that meet their needs and when appropriate, assist members in obtaining appointments with the provider.
- Assist members with access to medically necessary, quality healthcare in a cost-effective setting.
- Assist member in answering their complex medical questions.
- Assist members in locating available community resources.
- Development of a variety of health care education topics for represented membership.
- Assist members with appealing health carrier’s denial of medically appropriate care.
- Education & Experience
- Must be a Registered Nurse
- Certified Case Manager a plus
- At least 5 years of clinical experience preferably with an insurance company or Managed Care Company.
- Demonstrated proficiency using Microsoft Office applications.
- Dynamic personality with excellent presentation skills.
- Comfortable working with various data analytics platforms to identify gaps in care and mitigatable risk.
- Excellent written and verbal communication skills
- Excellent time management and project management skills
- Ability to articulate thoughts and speak clearly and professionally.
- Company Paid Life Insurance, Long-Term and Short-Term Disability.
- Medical, Dental, Vision and FSA/HSA plans.
- 401(k) with company match.
- Additional voluntary benefits including Critical Illness, Accident Insurance, Hospital Indemnity and Supplemental Life Insurance, Legal and Identity Protection, and Pet benefits.
- Generous PTO.
- An awesome team of professionals!