Clinical Advisor - LH

Luminare Health

1d

About The Position

At Luminare Health, the Clinical Advisor is a pivotal role responsible for providing daily client support within the Health Care Management department. Reporting to the Senior Director, Clinical Consultant, this position involves supporting members and clients on a day-to-day basis, as well as strategic collaboration with various Healthcare Management and non-Healthcare Management teams to ensure client needs are met. The Clinical Advisor will work to align current Utilization Review and Case Management workflows and processes with the requirements of new and existing clients. A key aspect of the role is maintaining an active and visible presence with both internal and external (client-facing) clients to manage and support business needs and growth. The advisor will also support the Senior Director, Clinical Consultant by fostering active communication and relationships with internal and external stakeholders across sales, clinical teams, client management, claims, and managed care, to deliver effective solutions and results for the business.

Requirements

• 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.
• 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.)
• Strong organizational skills with attention to detail
• A demonstrated ability to adapt, quickly learn new skills and serve as a sponsor of change
• Critical thinking skills allowing one to carry out instruction furnished in written, oral or diagram form
• A demonstrated ability to think/work/prioritize independently
• Demonstrates knowledge of Microsoft Office Suite products
• Ability to travel as needed

Nice To Haves

• 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

Responsibilities

• Providing day to day client support on behalf of the Health Care Management department
• Support our members and clients day to day
• Strategically collaborate with all Healthcare Management and non-Healthcare Management team members to ensure the needs of our clients are met
• Ensure our current workflows and processes for Utilization Review and Case Management meet the needs of new and existing clients
• Have active visible presence with internal and external (client facing) clients for management and support for our business needs and growth
• Support the Senior Director, Clinical Consultant by maintaining active communication and relationships with all internal and external stake holders in sales, clinical teams, client management, claims, managed care, etc. to deliver solutions and results for our business
• Actively manage and delivery on client expectations around projects, timelines, deliverables, outcomes, etc.
• Evaluate problems, develop alternative solutions and identify trends and patterns
• Deal with problems involving several concrete variables in standardized situation
• Prioritize efforts when faced with tight deadlines and multiple, complex projects
• Maintain high level of confidentiality, flexibility and willingness to learn new tasks and take on new duties as needed
• Carry out instruction furnished in written, oral or diagram form
• Think/work/prioritize independently
• Write/create routine correspondence and reports
• Read and interpret documents, criteria, instructions, and policy and procedure manuals
• Travel as needed

Benefits

• meaningful benefits to our employees to support their life outside of work
• 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
• robust total rewards package for associates
• annual incentive bonus plan subject to the terms and the conditions of the plan

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 1-10 employees