Company :Highmark IncJob Description :
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, 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.
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. May accompany sales to attend and, at times, present at client meetings. Provide support and participate in sales finalist meetings from a clinical services perspective by providing the clinical insight into value to members and clients. This is a client-facing 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 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.
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.
Other duties as assigned or requested.
Bachelor's Degree in Nursing or Health Administration
5 - 7 years in the Health Insurance Industry
5 - 7 years in Clinical Services
Written & Oral Presentation Skills
Relationship-builder with Unsurpassed Interpersonal Skills
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 their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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Allegheny Health Network