Clinical Services Assistant Manager
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Job Description
Clinical Services Assistant Manager leading a team of clinical experts for Claims operations. Overseeing clinical services, driving process improvements, and promoting clinical resources within the organization.
Responsibilities:
- Lead daily clinical services operations including nurse case management, pharmacy, nurse review, and bill review functions.
- Evaluate referrals and claim complexity, assigning work to internal staff or vendor partners.
- Manage team workload, priorities, turnaround times, and overall service delivery.
- Ensure clinical services are effectively integrated into claims handling processes and partner closely with claim professionals.
- Lead, coach, develop, and monitor the performance of the Clinical Services team.
- Oversee operational reporting, recommend KPIs, and monitor vendor performance and outcomes.
- Partner with Claims leadership to expand clinical services, improve consultation practices, and enhance service quality.
- Support implementation of new tools, clinical programs, regulatory changes, and vendor solutions.
- Identify training needs, develop educational programs, and promote clinical services throughout the organization.
- Drive process improvement initiatives that enhance efficiency, quality, and claim outcomes.
Requirements:
- Current Registered Nurse (RN) license
- Bachelor’s degree in nursing (BSN) preferred
- Eight years of nursing experience including at least four years of property and casualty clinical claim oversight
- Legal Nurse Consultant Certified (LNCC) designation, Case Management (CM), or other applicable designations preferred
- Experience in multiple medical specialties preferred
- Previous leadership or supervisory experience preferred
Benefits:
- Health insurance
- 401(k) matching
- Competitive paid time off plan
- Full day of volunteer time off annually
- Financial incentives including pension plan and bonus plan
- Professional development and growth opportunities including tuition reimbursement
- Wellness initiatives to improve team member well-being and reduce health insurance costs
- Flexibility to dress for your day and opportunities for alternative work arrangements
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