Clinical Services Assistant Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee daily operations of clinical services, encompassing nurse case management, pharmacy, nurse review, and bill review activities.

• Assess referrals and claim complexities, delegating tasks to internal teams or vendor partners.

• Supervise team workload, establish priorities, manage turnaround times, and ensure optimal service delivery.

• Guarantee that clinical services are seamlessly integrated into claims handling, collaborating closely with claims professionals.

• Lead, mentor, develop, and evaluate the performance of the Clinical Services team.

• Manage operational reporting, propose key performance indicators (KPIs), and track vendor performance and results.

• Collaborate with Claims leadership to broaden clinical services, enhance consultation practices, and improve service quality.

• Assist in the implementation of new tools, clinical programs, regulatory updates, and vendor solutions.

• Identify training requirements, create educational programs, and advocate for clinical services across the organization.

• Propel initiatives for process improvement that boost efficiency, quality, and claim outcomes.

⛳️ Requirements

• Valid Registered Nurse (RN) license.

• Bachelor’s degree in nursing (BSN) is preferred.

• A minimum of eight years of nursing experience, including at least four years in property and casualty clinical claim oversight.

• Legal Nurse Consultant Certified (LNCC) designation, Case Management (CM), or other relevant certifications are preferred.

• Experience across various medical specialties is preferred.

• Previous leadership or supervisory experience is preferred.

🏝️ Benefits

• Health insurance.

• 401(k) matching.

• Competitive paid time off plan.

• Full day of volunteer time off each year.

• Financial incentives, including a pension plan and bonus opportunities.

• Opportunities for professional development and growth, including tuition reimbursement.

• Wellness programs aimed at enhancing team member well-being and lowering health insurance costs.

• Flexibility in dress code and options for alternative work arrangements.