Company :
Highmark Inc.Job Description :
JOB SUMMARY
This job is responsible for the overall clinical support of account and sales specific activities within the Clinical Services division. The incumbent works with leaders in clinical services and sales/account management as a liaison, developing collaborative relationships across departments such as sales, actuary, underwriting, product and marketing to provide clinical content research for clients, clinical expertise for high-cost reporting, RFP responses, preparation for client meetings, and tracking of performance guarantees including participation in strategies to improve outcomes.
ESSENTIAL RESPONSIBILITIES
Develop collaborative relationships across various departments such as sales, actuary, product, marketing and others, as identified. Actively collaborate with account managers, clinical sales consultants, and other key stakeholders in preparation for client meetings. Support sales when prepping for client meetings. Provide support for sales finalist meetings from a clinical services perspective by providing the clinical insight into value to members and clients. This is a client-supporting role.
Support the clinical management team to assure that there are clear expectations for Case Managers & Disease Managers as it relates to specific models and client accounts. Provide new client implementation and ongoing support for clinical teams for buy-up products. Work with clinical managers to coach nurses on identified opportunities specific to client expectations.
Serve as primary leader in coordination and preparation for client audits and clinical reviews assuring that all requirements established by the client including contractual obligations are met and staff involved in any onsite reviews are adequately prepared and coached.
Work with the Member Listening System (MLS) team to align new cohorts or changes in existing cohorts to maintain contractual agreements.
Liaison between Sales and Clinical teams to field sales and client requests for case management referrals, metrics and case escalations, and success stories.
Analyze, synthesize, and provide clinical detail on High-Cost Claims & Authorization reports leveraging many systems and programs.
Serve as the clinical subject matter expert for RFPs. Work with the clinical writing team to support the strategy in submissions.
Manage the day-to-day performance operations for all Well 360 Products
Obtain, monitor and analyze data, monitor the performance of the buy up models.
Other duties as assigned or requested.
EDUCATION
Required
Bachelor's Degree in Nursing or clinical-related field OR relevant experience and/or education as determined by the company in lieu of bachelor’s degree
Preferred
None
EXPERIENCE
Required
5 years of clinical or managed care experience
Preferred
Health insurance experience
LICENSES OR CERTIFICATIONS
Required
None
Preferred
Registered Nurse (RN)
SKILLS
Written & Oral Presentation Skills
Analytical Skills
Relationship-builder with Unsurpassed Interpersonal Skills
Project Management
Reporting
Sales Support
Leadership
Languages (other than English)
None
Travel Requirement
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-Based
Physical work site required
Yes
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
$86,400.00Pay Range Maximum:
$138,600.00Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
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