[Hiring] Clinical Advisor @Luminare Health

Role Description

The Clinical Advisor is responsible for providing day-to-day client support on behalf of the Health Care Management department. Under the direction of the Senior Director, Clinical Consultant, the primary responsibilities will include:

• Supporting members and clients day-to-day.
• Strategically collaborating with all Healthcare Management and non-Healthcare Management team members to ensure client needs are met.
• Ensuring current workflows and processes for Utilization Review and Case Management meet the needs of new and existing clients.
• Maintaining an active visible presence with internal and external clients for management and support for business needs and growth.
• Supporting the Senior Director, Clinical Consultant by maintaining active communication and relationships with all internal and external stakeholders in sales, clinical teams, client management, claims, managed care, etc.

Qualifications

• Associate Degree
• Active State Registered Nursing License
• Minimum five years’ experience in direct clinical care and/or
• Minimum of three years’ experience in medical management including case management or utilization management
• Minimum 1 year in healthcare consulting (client-facing role or experience in delivery of results to clients)
• Knowledge of Health Care, Industry and Managed Care Delivery systems, including current standards of medical practice, insurance benefit structure, related legal/medical issues, utilization management, case management, and quality management processes.

Requirements

• Ability to actively manage and deliver on client expectations around projects, timelines, deliverables, outcomes, etc.
• Experience working with all levels within a client organization.
• Excellent oral, written, and presentation communication skills with the ability to interact effectively with new and existing clients and other internal clients (e.g., claims, client management, senior leadership, etc.).
• Ability to evaluate problems, develop alternative solutions, and identify trends and patterns.
• Ability to deal with problems involving several concrete variables in standardized situations.
• Ability to prioritize efforts when faced with tight deadlines and multiple, complex projects.
• Strong organizational skills with attention to detail.
• A demonstrated ability to adapt, quickly learn new skills, and serve as a sponsor of change.
• Maintain a high level of confidentiality, flexibility, and willingness to learn new tasks and take on new duties as needed.
• Critical thinking skills allowing one to carry out instructions furnished in written, oral, or diagram form.
• A demonstrated ability to think/work/prioritize independently.
• Work in a dynamic team-oriented environment.
• Write/create routine correspondence and reports.
• Read and interpret documents, criteria, instructions, and policy and procedure manuals.
• Ability to travel as needed.
• Demonstrates knowledge of Microsoft Office Suite products.

Preferred Job Qualifications

• Bachelor of Science in Nursing
• Prior Utilization Management and/or Case Management experience
• TPA or Health Insurance related experience
• Personnel management experience a plus
• Strong consultative and analytical skills

Benefits

• Health and wellness benefits
• 401(k) savings plan
• Pension plan
• Paid time off
• Paid parental leave
• Disability insurance
• Supplemental life insurance
• Employee assistance program
• Paid holidays
• Tuition reimbursement
• Other incentives

Pay Transparency Statement

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and conditions of the plan.

Min to Max Range: $67,600.00 - $127,000.00

Exact compensation may vary based on skills, experience, and location.