Clinical Integration Manager

2 weeks ago


Boise, Idaho, 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, providing clinical content research, expertise, and support for clients, RFP responses, and client meetings.

Key Responsibilities
  • Develop and maintain collaborative relationships with sales, actuary, product, and marketing teams to provide clinical content research and expertise.
  • Support the clinical management team in ensuring clear expectations for Case Managers and Disease Managers regarding 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.
  • Serve as the primary leader in coordination and preparation for client audits and clinical reviews, ensuring all requirements are met and staff involved are adequately prepared and coached.
  • 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
  • Bachelor's Degree in Nursing or clinical-related field.
  • 5 years of clinical or managed care experience.
  • Health insurance experience preferred.
  • Registered Nurse (RN) certification preferred.
Skills
  • Strong analytical and problem-solving skills.
  • Excellent written and oral communication skills.
  • Ability to build and maintain strong relationships with stakeholders.
  • Project management and leadership skills.
Work Environment

This role is office-based with occasional travel required.



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