RN Clinical Referral Manager - Workers Compensation

Paradigm•Phoenix, AZ

75d•Remote

About The Position

Paradigm is hiring a Clinical Referral Manager for a remote, full-time, benefited position. The Clinical Referral Manager provides clinical support for the Catastrophic Referral Intake Unit.

Requirements

Registered Nurse (with active, unencumbered license)
Minimum of 3-5 years’ experience in catastrophic case management, referral intake or sales
Experience in insurance preferred.
Demonstrated ability to define, manage and modify operational processes and workflows.
Demonstrated ability to work collaboratively to address operational and customer requests.
Intermediate to advanced level computer experience and Windows software, proficient in Microsoft product suite with advanced skills in Excel.
Exceptional critical-thinking and creative problem-solving skills with proven ability to collaborate with others to identify alternatives and drive to resolution.
Strong communication and facilitation skills including the ability to resolve issues and build consensus among groups of diverse internal/external stakeholders;
Ability to deliver effective presentations to internal and external customers.
Ability to work effectively autonomously and/or in a matrixed environment;
Ability to be flexible and responsive to change.
Excellent interpersonal skills with an ability to influence and lead through change.
Ability to review and assess complex medical records and convey pertinent information to non-medical stakeholders

Nice To Haves

Experience working as a Network Manager and using EDDG preferred

Responsibilities

Assist with assignment of the Primary Medical Team and Network Managers to new referrals.
Evaluate incoming and existing referrals to determine appropriate product placement based on specified criteria.
Assist the Catastrophic Referral Intake Unit in reviewing new referral escalations for appropriate product placement.
Assess clinical conditions, treatment plans, and required resources.
Escalate referrals that need additional or advanced services.
Identify key stakeholders and responsible parties for each referral.
Build and maintain strong relationships with stakeholders to ensure effective handling of catastrophic referrals.
Provide education and support to customers regarding Paradigm products and services.
Review active field case management files to identify opportunities for conversion to risk-bearing products.
Analyze referrals that were unstaffed or withdrawn, gather relevant data, and provide insights to the sales team for potential conversion.
Develop strategies to increase the scope of referrals considered for conversion and collaborate with other business units to implement these processes.
Track and maintain data on referral conversions, including revenue and cases that were not successfully converted.