• Review of a variety of health plan data and the ability to develop clinical findings and projections of future spend.

• Use of clinical knowledge to work with health insurance carriers to ensure appropriate clinical care coordination.

• Work with employer to develop an appropriate a health risk management plan.

• Work closely with our Account Management Team to develop a cohesive plan to control costs within the health plan.

• Assist members in identifying participating providers that meet nd when appropriate, assist members in obtaining appointments with the provider.

• Assist members with access to medically necessary, quality healthcare in a cost-effective setting

• Assist member in answering their complex medical questions.

• Assist members in locating available community resources.

• Development of a variety of health care education topics for represented membership.

• Assist members with appealing health carrier’s denial of medically appropriate care.

Qualifications:

• Must be a Registered Nurse

• Certified Case Manager a plus

• At least 5 years of clinical experience preferably with an insurance company or Managed Care Company.

• Demonstrated proficiency using Microsoft Office applications

• Dynamic personality with excellent presentation skills.

• Comfortable working with various data analytics platforms to identify gaps in care and mitigatable risk.

• Excellent written and verbal communication skills

• Excellent time management and project management skills

• Ability to articulate thoughts and speak clearly and professionally

Benefits: 

• Company Paid Life Insurance, Long-Term and Short-Term Disability.

• Medical, Dental, Vision and FSA/HSA plans.

• 401(k) with company match.

• Additional voluntary benefits including Critical Illness, Accident Insurance, Hospital Indemnity and Supplemental Life Insurance, Legal and Identity Protection, and Pet benefits.

• Generous PTO.

• An awesome team of professionals!

The Hilb Group is an equal opportunity employer, and we actively support and comply with all applicable federal, state, and local laws prohibiting all forms of discrimination in employment. Additionally, we have a zero-tolerance policy for all forms of harassment in violation of federal, state, and local laws.