Clinical Consultant - Case Manger (RN)
Location
Maple Grove, MN | United States
Job description
PartnerRe Ltd. is a leading global reinsurer, providing multi-line risk management solutions around the world. Risks reinsured include property, casualty, motor, agriculture, aviation/space, catastrophe, credit/surety, engineering, energy, marine, specialty property, specialty casualty, multiline and other lines, mortality, longevity, health, and alternative risk products.
PartnerRe Health , the global Health Division of PartnerRe, is an acknowledged leader in providing risk management solutions to accident and health markets. The PartnerRe team of experienced professionals develops innovative, client-specific solutions by thoroughly understanding our clients’ goals, market, risk tolerance and exposures. Using a suite of proven proprietary financial and analytical tools, an effective risk management program is designed with extensive support services.
PartnerRe’s PULSE + Plus™ Medical Management Program is an integrated, state-of-the-art program that partners with our clients to proactively manage healthcare risk exposures and find optimal solutions for evolving healthcare challenges. PULSE + Plus™ Medical Management helps optimize both clinical and financial outcomes through a wide range of value-creating services that enhance risk protection at multiple levels. Program features include:
- Rare, complex and chronic disease management and network solutions
- Transplant center of excellence networks and contract evaluation
- Proactive approach to managing quality and cost of care
- Board-certified specialty physician panel, with physician-driven consultation services
- Comprehensive analytical auditing services; hospital and physician claim audits
- Top-tier primary and supplemental PPO networks with supplemental contract negotiations
- Specialty pharmacy management and network
- Advocacy for supplemental payers
- Educational support and webinars
Job Description
SCOPE AND RESPONSIBILITIES:
The PULSE Clinical Consultant role is to serve as risk managers, working closely with our clients internal stakeholders to educate, validate, collaborate and solve complex and costly medical reimbursement issues. As clinical experts, our clinical consultants are able to identify and understand a clients’ risk profile, educate on how to more effectively manage that risk and work with a variety of specialty service providers to generate optimal outcomes both clinically and financially. They provide clinical expertise to PartnerRe’s underwriting and claims departments to ensure insightful administration of PartnerRe Health’s products.
JOB DUTIES
The following reflects management’s definition of essential functions for this position but does not restrict the responsibilities that may be assigned. Management may assign or reassign duties and responsibilities to this job at any time due to reasonable accommodation or other reasons.
- Develop relationships with assigned clients and producers.
- Review assorted claims, trigger reports, and 50% notice reports to identify catastrophic diagnoses or cases of concern for intervention.
- Obtain additional medical or financial information from the client, if there are outstanding questions on a member’s case
- Collaborate closely with claims team and underwriters, providing a seamless and integrated client experience.
- Understand nuances of each line of business and adjust activities and interventions based on the uniqueness of each market segment.
- Educate clients to better understand risk and how to manage it.
- Leverage opportunities to insert cost management services to reduce risk.
- Manage relationships with specialty service providers as appropriate.
- Notify key stakeholders of cases that breach our reinsurance layer.
- Notify management of cases exceeding a specific threshold into our layer.
- Escalate cases of concern as outlined in our standard operating procedures.
- Implement new clients regarding PULSE + Plus ™ services.
- Analyze transplant contracts with our various networks to select optimal contract.
- Deliver appropriate information and documents to client and/or producer following implementation.
- Create and maintain client profiles in PULSE + Plus ™ database.
- Document and maintain records of medical management services selected by each client.
- Track medical management interventions and savings by client and prepare savings reports for clients and brokers.
- Stay on top of current high risk market trends, specialty drugs and gene and cellular therapies through research and conference attendance.
Qualifications
Computer Skills
- Must be proficient in Microsoft programs including but not limited to Excel, Access, Outlook and Word. Must be able to learn other software programs required by the department.
Education and/or Experience
- Current Registration with Minnesota Board of Nursing.
- Bachelor’s degree in nursing, or Associates degree with comparable experience
- 5+ clinical experience is required
- 1-3 years of insurance or reinsurance industry experience is preferred
- NICU/Pediatric experience is preferred
- Commission for Case Management Certification (CCM) is preferred
Other Skills and Abilities
- Must have or be able to quickly acquire knowledge of departmental program structure (mission, goals and objectives), department policies and procedures.
- Must have a sound knowledge and ability in business correspondence and an ability to proofread for grammar, spelling and punctuation with a high degree of accuracy.
- Must be able to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rates, obtain ratios and percentages and to draw and interpret bar graphs.
- Must maintain professional and technical expertise through participation in continuing education as necessary.
- Ability to handle multiple interruptions and adjustments to priorities throughout the day.
- Ability to communicate effectively with diverse individuals and to calmly and efficiently handle situations ranging from routine to urgent.
- Excellent memory and organizational ability, in order to set priorities, organize workload, handle multiple responsibilities and meet deadlines.
- Proficient on standard office equipment including personal computer, multi-line telephone system, fax machine, copier, scanner.
Personal attributes / Common culture:
- Serves our stakeholders with purpose, successfully and efficiently
- Lives our values in all we do
- Sets the standard by which customers and competitors judge themselves
- Raises the bar for ourselves, on behalf of our clients
- Represents the highest level of professionalism in our industry; embodying honesty, integrity, maturity and appropriateness
- Respects and honors each employee as a valued member of our team
- Fosters a unified team spirit where we all work for the success of each individual
- Maximizes the strengths and minimizes the weaknesses of our employees
- Motivates, trains and develops its people personally and professionally; calling them to share and participate in our Mission, Values, Vision and Goals
- Sustains an environment of direct and respectful communication
- Provides new creative solutions for the needs of our clients
- Addresses value migration proactively and with vigor
- Reinvents itself, continually — thriving in a state of disequilibrium
- Cannibalizes our own products and services to create new trends and solutions (rather than react to current ones), in anticipation of changes in the broader accident and health market
- Is led by a Management Team that, with unity and purpose, is intentionally building something that will survive them
Additional Information
#LI-Hybrid
PartnerRe provides a working environment in which diversity is valued, where all employees feel welcome, respected, and empowered to perform at their best. We invite you to learn more about D&I at PartnerRe.
Thank you,
PartnerRe Hiring Team
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