Clinical Advisor - LH

Health Care Service Corporation

About The Position

At Dearborn, employees are the cornerstone of the business and the foundation to success, empowered with curated development plans that foster growth and promote rewarding, fulfilling careers. 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 include supporting members and clients daily and strategically collaborating with all Healthcare Management and non-Healthcare Management team members to ensure client needs are met. The Clinical Advisor will strategically collaborate with these teams to ensure current workflows and processes for Utilization Review and Case Management meet the needs of new and existing clients. The position also requires an active visible presence with internal and external (client facing) clients for management and support of 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 stakeholders in sales, clinical teams, client management, claims, managed care, etc., to deliver 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, including 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.

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 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.
Maintain active visible presence with internal and external (client facing) clients for management and support for business needs and growth.
Support the Senior Director, Clinical Consultant by maintaining active communication and relationships with all internal and external stakeholders in sales, clinical teams, client management, claims, managed care, etc. to deliver solutions and results for the business.