Clinical Advisor - LH

Luminare Health

12d•$67,600 - $127,000•Remote

About The Position

At Luminare Health, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary The Clinical Advisor is responsible for providing day to day client support on behalf of the Health Care Management department. Under the direction of the Senior Director, Clinical Consultant, the primary responsibilities will be to support our members and clients day to day and strategically collaborate with all Healthcare Management and non-Healthcare Management team members to ensure the needs of our clients are met. The Clinical Advisor will strategically collaborate with these teams to ensure our current workflows and processes for Utilization Review and Case Management meet the needs of new and existing clients. The position will have additional responsibility to have active visible presence with internal and external (client facing) clients for management and support for our business needs and growth. The Clinician Advisor will 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.

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
Demonstrates knowledge of Microsoft Office Suite products.

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

Provide day to day client support on behalf of the Health Care Management department.
Support 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.
Strategically collaborate with teams to ensure 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.
Maintain 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 deliver 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.