Clinical Integration Manager

5 days ago


Turner, Oregon, United States Highmark Health Full time
Job Summary

This role is responsible for providing clinical support to account and sales activities within the Clinical Services division. The incumbent will work closely with leaders in clinical services and sales/account management to develop collaborative relationships across departments, including sales, actuary, product, and marketing.

Key Responsibilities
  • Develop and maintain collaborative relationships with various departments to provide clinical content research for clients and clinical expertise for high-cost reporting.
  • Collaborate with account managers, clinical sales consultants, and other key stakeholders to prepare for client meetings and provide clinical insight into value to members and clients.
  • Support the clinical management team to ensure clear expectations for Case Managers & Disease Managers as it relates to specific models and client accounts.
  • Provide implementation and ongoing support for clinical teams for buy-up products.
  • Work with clinical managers to coach nurses on identified opportunities specific to client expectations.
  • Coordinate and prepare for client audits and clinical reviews to ensure all requirements established by the client, including contractual obligations, are met.
  • Analyze and provide clinical detail on High-Cost Claims & Authorization reports.
  • Serve as the clinical subject matter expert for RFPs and work with the clinical writing team to support the strategy in submissions.
Requirements
  • Required: Bachelor's Degree in Nursing or clinical-related field, or relevant experience and/or education as determined by the company in lieu of a bachelor's degree.
  • Preferred: 5 years of clinical or managed care experience, health insurance experience, and/or Registered Nurse (RN) certification.
Work Environment

This is an office-based position with occasional travel required. The incumbent will work primarily out-of-the office selling products/services and will be required to lift up to 10 pounds frequently.


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