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Clinical Support Manager

Register Nurse - Clinical Case Manager Description

As the clients self-insured Registered Nurse/Clinical Case Manager our clinical team must be proactive in seeking better outcomes, consistent reach out and assurances and communications with all plan members advancing to case management, disease management and utilization management.

Working with other client teams and outsourced plan partners that participate in our weekly or monthly clinical inventory reviews, all partners must be provided accurate and the most updated clinical estimates, a brief HIPAA PHI protected general diagnosis and future cost estimates as the condition evolves.

Maintaining clinical inventories by client, as Clinical Case Manager our clinical team must be proactive in seeking better outcomes, consistent reach out protocol and assurances and communications with all plan members advancing to Case Management, Disease Management or Utilization Management.

  • Obtain transitional care disclosures (TOC)
  • Request that a transitional care HIPAA PHI release is provided to the transitional care member
  • Provide a complete verbal and written communication to the transitional care plan member as to our role in providing clinical oversight and partnership with the current plan of treatment and all their providers
  • Request the names and contact information of all current treating providers
  • Provide all current providers a copy of the BAA and PHI release
  • Request all current and historical medical records, test results and x-rays from all current providers
  • Complete an evaluation of the plan members ongoing clinical diagnosis and course of current treatment
  • Schedule a clinical team meeting to review diagnosis, providers and course of treatment
  • Evaluate for escalated Center of Excellence opportunity
  • Schedule a call with the primary physician with our medical director and if required an expert in the area of diagnosis (this is meant to set levels of expectation and escalated care available within the plan management relationship)
  • Communicate with the plan member providing assurances that our in-depth clinical team will provide oversight and ensure the best transitional care

In working with other client teams who participate in our weekly or monthly clinical inventory reviews they MUST be provided accurate and the most updated clinical estimates, a brief HIPAA PHI protected general diagnosis and future cost estimates as the condition evolves

An ideal candidate will have 3-5 years of either case management or utilization management within the insurance industry, however inpatient experience will also be considered. Although not required, experience within the self-funded arena is preferred. Looking for a positive, team player not afraid to pick up the phone and get the job done. Understanding of team dynamics, collaboration, and effective communication are critical to the Clinical Support Manager role. Although most work is done either through phone calls, emails, or texts, the ideal candidate will have excellent bedside manner.

This role requires great analytical skills along with the ability to multitask and effectively manage your time. Clinical Case Manager must be proficient in all Microsoft applications including Excel, PowerPoint, Word, and Outlook.

Above all else, the Clinical Case Manager must be willing to learn and contribute to a team environment. As the Clinical Case Manager, you will be reporting directly to the Team Lead and Director and working with other members on the clinical team, including the Clinical and Pharmacy Director.

This is an excellent role with a fun team and incredible company, where every day is a new adventure. Located in Northern California, this role comes with a competitive salary and excellent benefits.

WHY JOIN US?

  • 15th Largest Broker in US
  • Voted " Best Place to Work" in the Insurance Industry
  • Awesome Benefits: 401K matching, Generous Time Off Policy, Flexible Work Options, Medical, Dental, Vision, Pet Insurance, Cancer Insurance, Wellness Programs, Employee Award Programs (Trips!).

EPIC embraces diversity in all its various forms-whether it be diversity of thought, background, race, religion, gender, skills or experience. We are committed to fostering a work community where every colleague feels welcomed, valued, respected and heard. It is our belief that diversity drives innovation and that creating an environment where every employee feels included and empowered, helps us to deliver the best outcome to our clients. An Equal Opportunity/Affirmative Action Employer.


Category

Clinical Nurse Specialists


Job type

Full time

Company
EPIC Brokers
Posted
10/02/2021
Salary Range
$89,000.00 - 177,000.00
per Year
Salary range estimated by
Location
Concord, CA 94529, US