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Clinical Navigator

2 months ago

Phoenix Arizona, United States Gallagher Full time
About the Role

Gallagher is seeking a skilled Clinical Navigator to join our global brokerage team. As a key member of our team, you will play a critical role in safeguarding businesses and empowering their ambitions.

Key Responsibilities
  • Ensure appropriate utilization of services and effective case/cost management.
  • Monitor and resolve escalated large claims issues.
  • Function as a liaison between referral source, physician and member and coordinate appropriate cost-effective solutions.
  • Claim review to ensure appropriate treatment and billing.
  • Collect and analyze data related to health outcomes, program participation, and satisfaction to assess the effectiveness of wellness initiatives and make data-driven recommendations for improvement.
  • Identify members for referral opportunities to integrate with other services (i.e. Case Management, Disease Management).
  • Collaborate with healthcare professionals, vendors, and other departments or teams to integrate health and wellness initiatives.
  • Serve as a resource and point of contact for employees or clients seeking information or support related to health and wellness.
  • Understanding and utilization of Case Management functions, self-funded insurance plans and PPO networks.
  • Knowledge and application of medical/health insurance terminology, ICD-9/ICD-10, HIPAA and DOL regulations.
  • Develop and deliver educational programs and materials to promote healthy lifestyle choices, disease prevention, and self-care management.
  • Collect and analyze data related to health outcomes, program participation, and satisfaction to assess the effectiveness of wellness initiatives and make data-driven recommendations for improvement.
  • Connect individuals with appropriate healthcare providers, community resources, and support services to address their specific health needs.
Requirements
  • Associate's degree from an accredited school of nursing.
  • Minimum of 3 years clinical experience in an acute care setting.
  • Active Registered Nursing license within the state of practice.
  • Desired:
    • BSN.
    • 3+ years clinical management experience.
    • Wellness/Health Coach experience.
    • 3+ year utilization management/case management experience in an insurance (non-hospital) setting.
    • 3+ years claims review experience including familiarity of reimbursement methodology.
    • Pre- and post-pay claims review and healthcare data experience preferred.
    • Experience in quality improvement related activities.
    • Knowledge of statistics, data collection, and survey design helpful.
Benefits

Gallagher offers a wide range of benefits, including:

  • Medical/dental/vision plans, which start from day one.
  • Life and accident insurance.
  • 401(K) and Roth options.
  • Tax-advantaged accounts (HSA, FSA).
  • Educational expense reimbursement.
  • Paid parental leave.
  • Digital mental health services (Talkspace).
  • Flexible work hours (availability varies by office and job function).
  • Training programs.
  • Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing.
  • Charitable matching gift program.
  • And more...