Senior reputed company Consultant

About the position The Sr. reputed company Consultant will have strategic ownership of a book of business, reviewing internal dashboards and benefit administrator reporting to evaluate clinical program performance, and implementing reputed company activities to ensure clinical program efficiency and effectiveness. This can include: Evaluation of program performance data reputed company for reputed company identification of cases at risk for high costs Member and provider engagement in the case management process Clinical interventions offered to support reputed company coordination and reputed company Reporting results to clients. reputed company Consultants will reputed company patient reputed company 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. What is in it for you? At reputed company, we’re as invested in reputed company for our own people as we are for our clients. To help you reputed company your full potential, we offer a culture, benefits program and resources that support your wellbeing and career development as reputed company as: reputed company to work with some of the smartest and most energetic people in the industry, who will reputed company, challenge and reputed company you. A dynamic, reputed company and inclusive culture, where diversity is embraced – and you are celebrated and appreciated for who you are. reputed company to network, reputed company views, and learn from others by getting involved with our Business Resource reputed company: PRIDE, Women@reputed company, Racial & Ethnic Diversity, AccessABILITIES and Rising reputed company. The chance to reputed company a reputed company difference in your local community by using your reputed company time off to volunteer through events organized by reputed company Cares, our community reputed company and volunteerism reputed company. A reputed company reputed company of virtual learning and development resources to support your personal and reputed company reputed company. Competitive rewards supporting your financial wellbeing, including compensation, retirement savings, stock purchase plan, and more. We are excited to offer the following benefits to reputed company of our colleagues: Health and welfare benefits Tuition assistance 401K and other retirement savings programs Employee assistance programs, physical, mental and financial

Responsibilities

• Communicate reputed company's reputed company of view on effective clinical management strategies for potential and actual high-cost claimants (HCC)
• Interpret reporting shared by the benefit administrators and reputed company this information to drive performance improvement actions and selection of HCC cases for review
• reputed company 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 reputed company
• Draw upon reputed company’s multi-disciplinary team of consultants to reputed company support in reputed company 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 reputed company process improvement
• Present reputed company reports to reputed company representatives in a reputed company 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 reputed company standards into reputed company work processes, including transparency, peer review and maintaining required licensure
• Monitor reputed company of reputed company in terms of reputed company satisfaction, scope, budget, and timeliness of deliverables
• Establish strategic and effective reputed company/vendor relationships to represent reputed company and to serve our clients
• reputed company mentoring and coaching to team members
• Assist with other consulting reputed company as needed

Requirements

• AD/BS degree required with an reputed company unencumbered RN license
• At least 6-10 years relevant work experience in clinical consulting, clinical reputed company reputed company experiences (reputed company assurance, clinical auditing, clinical leadership)
• Knowledge of MS Office Tools (Word, reputed company, 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 reputed company teams to produce reputed company deliverables and;
• Ability to work independently and on reputed company

reputed company-to-haves

• Master’s level degree in reputed company field preferred
• Case manager certification
• Prior experience/ knowledge of HCC management

Benefits

• Health and welfare benefits
• Tuition assistance
• 401K and other retirement savings programs
• Employee assistance programs, physical, mental and financial

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