Senior Medical Consultant II
About The Position
The Sr. Nurse Consultant will have strategic ownership of a book of business, reviewing internal dashboards, data files, and benefit administrator reporting to evaluate clinical program performance, and implementing oversight activities to ensure clinical program efficiency and effectiveness. This can include: evaluation of program performance data methods for timely identification of cases at risk for high costs member and provider engagement in the case management process clinical interventions offered to support optimal care coordination and outcomes reporting results to clients. Nurse Consultants will impact patient outcomes by providing feedback to benefit administrators and vendors about opportunities for improved care coordination and areas where their performance is in-line or exceeds best practices.
Requirements
- AD/BS degree required with an active unencumbered RN license
- At least 5-8 years relevant work experience in clinical consulting, clinical carrier related experiences (quality assurance, clinical auditing, clinical leadership)
- Knowledge of MS Office Tools (Word, Excel, PowerPoint, Teams).
- Proven project management, verbal and written skills with strong clinical acumen.
- Ability to establish and execute on strategic plans using creative problem-solving, and incorporating clinical data and metrics
- Ability to prioritize and handle multiple tasks in a demanding work environment.
- Ability to partner and lead teams to produce client deliverables
- Ability to work independently and on a team.
Nice To Haves
- Master’s level degree in related field preferred.
- Case manager certification.
- Prior experience/ knowledge of HCC management.
Responsibilities
- Communicate Mercer's point of view on effective clinical management strategies for potential and actual high-cost claimants (HCC).
- Interpret reporting shared by the benefit administrators and leverage this information to drive performance improvement actions and selection of HCC cases for review.
- Lead discussions with the benefit administrators’ clinical teams to identify strengths and opportunities in how cases are being managed and offer suggestions to shape the course of the members’ care moving forward.
- Draw upon Mercer’s multi-disciplinary team of consultants to provide support in oversight of HCC cases selected for review (e.g., physicians, pharmacists, behavioral health, compliance, etc.).
- Draft reports that reflect the results of the clinical case reviews with the administrators using a format that allows for tracking of trends over-time to support continuous process improvement.
- Present summary reports to client representatives in a clear and constructive manner, providing insights into value and next steps.
- Follow up with benefit administrators to ensure recommendations are being acted upon.
- Incorporate compliance and professional standards into all work processes, including transparency, peer review and maintaining required licensure.
- Monitor success of projects in terms of client satisfaction, scope, budget, and timeliness of deliverables.
- Establish strategic and effective carrier/vendor relationships to represent Mercer and to serve our clients.
- Provide mentoring and coaching to team members.
- Assist with other consulting projects as needed.
Benefits
- Health and welfare benefits
- Tuition assistance
- 401K and other retirement savings programs
- Employee assistance programs, physical, mental and financial
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Associate degree
