Clinical Navigator

Paradigm • Tampa, FL

75d • $73,000 - $88,000 • Remote

About The Position

Paradigm is seeking a Clinical Navigator to provide central coordination and clinical oversight for injured workers with complex and catastrophic workers’ compensation claims. The role partners with case managers, clinical associates, providers, payers, vendors, key accounts, and injured workers to remove barriers to care, support timely and medically necessary treatment, and promote positive outcomes. The Clinical Navigator helps ensure continuity of care, evaluates treatment appropriateness, escalates delays and risks, and delivers a high-quality, customer-first experience.

The position is fully remote and typically follows business hours, though work outside standard business hours may sometimes be required based on business needs. The ideal candidate is an active RN with 3–5 years of workers’ compensation and/or complex case management experience. Catastrophic case experience is strongly preferred; experience with DME, utilization review, EMRs, care management platforms, and Microsoft Office applications is also relevant. The role calls for a forward-thinking clinical professional who can work independently, take initiative, and collaborate to support high-quality outcomes for injured workers.

Requirements

• Active RN license; RN required.
• 3–5 years of workers’ compensation and/or complex case management experience.
• Experience with EMRs, care management platforms, and Microsoft Office applications.
• Knowledge of the Utilization Review process.
• Ability to communicate effectively and professionally with internal and external customers.
• Collaborative demeanor and strong emphasis on teamwork.
• Strong conflict-resolution and problem-solving abilities.
• Strong understanding of medical terminology.
• Strong clinical assessment and critical-thinking skills.
• Excellent prioritization and time-management skills.
• Strong documentation and auditing skills.

Nice To Haves

• Experience with catastrophic cases.
• Experience with DME.
• Bilingual English/Spanish.

Responsibilities

• Serve as the central point of coordination and clinical oversight for assigned complex and catastrophic cases.
• Provide secondary-level clinical oversight and serve as the single point of contact for Case Managers and Clinical Associates.
• Work with assigned key accounts and provide excellent customer service in every interaction.
• Apply case management skills and catastrophic workers’ compensation experience to remove barriers, with a focus on quality outcomes, compliance, and efficient case progression.
• Evaluate treatment appropriateness and utilization.
• Ensure home health and DME services are performed as ordered and remain clinically necessary; make recommendations based on injured workers’ needs and progress.
• Ensure treatment plans align with medical necessity and payer guidelines.
• Monitor injured worker progress and escalate delays or identified risks.
• Identify delays, risks, and care gaps, and escalate them appropriately.
• Conduct quality assurance on a predetermined number of referrals to ensure alignment with Care at Home guidelines and expectations.
• Collaborate with external agencies, providers, and vendors to coordinate care, facilitate communication, and ensure timely delivery of services and resources.
• Facilitate and lead case conferences and virtual roundtable discussions as needed to coordinate care, review patient progress, address treatment barriers, and align stakeholders on care plans and next steps.
• Develop an understanding of Paradigm’s organization, products, operations, and customers; prioritize collaboration, meet customer needs and expectations, and take personal accountability for service quality.
• Use AI tools to support day-to-day tasks, improve efficiency, and enhance output quality; adopt new technologies as trained and apply them in accordance with established processes and guidelines.

Benefits

• PPO, HDHP, and HMO health insurance options through Cigna and Kaiser (Kaiser for California employees only).
• Competitive salaries.
• 401(k) matching contributions.
• Employer-paid life and disability insurance.
• Flexible spending and commuter accounts.
• Employer-matched HSA contributions.
• Paid time off and personal holiday programs.
• One paid volunteer day per calendar year for full- and part-time employees.
• Learning and development support, including the Learning Excellence at Paradigm (LEAP) program.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed