Clinical Advisor

3 weeks ago

Phoenix Arizona, United States Gallagher Full time
About Us:
Indulge your passion for problem-solving and embrace the thrill of addressing risk head-on at Gallagher's global brokerage team. Join a family of diverse minds, united by a relentless pursuit of excellence. As part of our team, you'll be the architect of protection, safeguarding businesses and empowering their ambitions. Together, we'll build a legacy of trust and triumph in the dynamic world of risk management.

 

We believe that every candidate brings something special to the table, including you So, even if you feel that you’re close but not an exact match, we encourage you to apply.

Responsibilities:
Monitor utilization review and case management activities of insurance carrier for accuracy and effectiveness.

Ensure appropriate utilization of services and effective case/cost management.

Coordinate and manage large claim processing and payments.

Monitor and resolve escalated large claims issues.

Act as a liaison between referral source, physician and member and coordinate appropriate cost-effective solutions.

Review claims paying over $25k.

Review claim denials.

Recommend solutions to non-standard requests and issues.

Identify members for referral opportunities to integrate with other services (i.e. Case Management, Disease Management, COE).

Periodic review of open subrogation cases.

Develop and implement health and wellness programs.

Collaborate with healthcare professionals, vendors, and other departments or teams to integrate health and wellness initiatives.

Monitor and evaluate health and wellness programs through data collection and analysis.

Organize and manage wellness events to encourage healthy behaviors and engagement.

Maintain accurate records and documentation of program participation, outcomes, and expenses.

Serve as a resource and point of contact for employees or clients seeking information or support related to health and wellness.

Qualifications:
Required

Current Arizona RN license in good standing.

3+ years in the healthcare industry, including wellness, nutrition, or exercise physiology.

Valid IVP Fingerprint Clearance Card within 60 days of hire.

Ability to succeed in a hybrid role – local travel between locations and corporate three-four days a week.

Preferred

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.

Utilization management/case management experience in an insurance (non-hospital) setting is beneficial.

Skilled in the use of personal computers and general office software, including Microsoft Word, Excel, and PowerPoint.

Pre- and post-pay claims review and healthcare data experience preferred.

Experience in quality improvement related activities.

BSN preferred.

Case management experience is preferred.

Experience with program development.

Bi-lingual is a plus.

Additional Information:
On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits. 

 Below are the minimum core benefits you’ll get, depending on your job level these benefits may improve:

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

Other benefits include:

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...

We value inclusion and diversity

to review our U.S. Eligibility Requirements

Inclusion and diversity (I&D) is a core part of our business, and it’s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work.

Gallagher embraces our employees’ diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest.

Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as “protected characteristics”) by applicable federal, state, or local laws.

Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.

 

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