Note: The job is a remote job and is open to candidates in USA. Luminare Health is dedicated to making healthcare simpler, better, and more affordable. The Clinical Advisor will provide client support, collaborate with teams to ensure client needs are met, and maintain communication with stakeholders to deliver effective healthcare management solutions.
Responsibilities
- Provide day to day client support on behalf of the Health Care Management department
- Support our members and clients day to day and strategically collaborate with all Healthcare Management and non-Healthcare Management team members
- Ensure the needs of our clients are met
- Collaborate with teams to ensure workflows and processes for Utilization Review and Case Management meet client needs
- Maintain active communication and relationships with all internal and external stakeholders
- Support and implement appropriate clinical related products, services and initiatives
- Develop workflows and processes
- Partner with HCM operational units and client management teams to ensure client needs are understood and implemented
- Develop, implement, and document procedures and standards that ensure delivery of results that satisfy quality, compliance, and timeliness
- Assist HCM teams by providing analysis of current medical/claims trends
- Collaborate with all HCM and Non-HCM areas to ensure timely, accurate information flows
- Identify opportunities for improved quality assurance measures
- Contribute to the development, maintenance, and revision of department policies and procedures
- Review and identify areas in need of improved efficiency
- Serve as a clinical resource for sales and client management
- Attend client meetings as requested as a Clinical Representation
- Assist in pulling client specific reports and providing clinical analysis to clients
- Provide feedback to prospective and existing clients regarding Healthcare Management Clinical Programs
- Assist in the development of client’s Prior Authorization Lists
- Maintain current basic knowledge Intake Team, Utilization Management and the Case Management Process
- Serve as a Clinical Resource to support Client Management Team and Healthcare Management Department
- Prioritize daily work assignments to meet division goals and customer requirements
- Participate in Quality Improvement initiatives as appropriate
- Other duties as assigned and needed
- Travel as required for client meetings
Skills
- Associate Degree
- Active State Registered Nursing License
- Minimum five years' experience in direct clinical care and/or
- Minimum of three years' experience in medical management including case management or utilization management
- Minimum 1 year in healthcare consulting (client facing role or experience in delivery of results to clients)
- Knowledge of Health Care, Industry and Managed Care Delivery systems. This includes current standards of medical practice, insurance benefit structure, related legal/medical issues, utilization management, case management and quality management processes
- Ability to actively manage and delivery on client expectations around projects, timelines, deliverables, outcomes, etc
- Experience working with all levels within a client organization
- Excellent oral, written and presentation communication skills with the ability to interact effectively with new and existing clients and other internal clients (ie: claims, client management, senior leadership, etc.)
- Evaluate problems, develop alternative solutions and identify trends and patterns
- Deal with problems involving several concrete variables in standardized situation
- Ability to prioritize efforts when faced with tight deadlines and multiple, complex projects
- Strong organizational skills with attention to detail
- A demonstrated ability to adapt, quickly learn new skills and serve as a sponsor of change
- Maintain high level of confidentiality, flexibility and willingness to learn new tasks and take on new duties as needed
- Critical thinking skills allowing one to carry out instruction furnished in written, oral or diagram form
- A demonstrated ability to think/work/prioritize independently
- Work in a dynamic team-oriented environment
- Write/create routine correspondence and reports
- Read and interpret documents, criteria, instructions, and policy and procedure manuals
- Ability to travel as needed
- Demonstrates knowledge of Microsoft Office Suite products
- Bachelor of Science in Nursing
- Prior Utilization Management and/or Case Management experience
- TPA or Health Insurance related experience
- Personnel management experience a plus
- Strong consultative and analytical skills
Benefits
- Health and wellness benefits
- 401(k) savings plan
- Pension plan
- Paid time off
- Paid parental leave
- Disability insurance
- Supplemental life insurance
- Employee assistance program
- Paid holidays
- Tuition reimbursement
- Other incentives
- Annual incentive bonus plan subject to the terms and the conditions of the plan
Company Overview