Berkley

  • Manager, Clinical Cost Containment RN

    Location Name NJ, Hamilton Square
    ID
    2019-3515
    Date Posted
    1 month ago(1/6/2020 5:39 PM)
    Company
    Berkley Accident & Health
    Primary Location
    US-NJ-Hamilton Square
    Category
    Managed Care
  • Company Details

    Berkley_Accident_&_Health_Logo

    Responsibilities

    The Manager, Clinical Cost Containment reports to the Director of Health Risk Management and is responsible for the Clinical Cost Containment department. S/he fosters and maintains solid working relationships with both external clients and internal resources via a strong professional network and keeping abreast of new developments affecting case management, health care cost and specialty vendor resources. Our Clinical Cost Containment team plays an integral role in support of Berkley's vision to be recognized as the industry leader in risk management service. This role is responsible for assuring optimal clinical outcomes are obtained at a cost commensurate with the level of medical services rendered while also promoting client satisfaction and retention.  Duties and responsibilities include but are not limited to:

    • Leads, manages, hires, trains, retains and motivates a team of clinical RNs and para-clinical professionals capable of and committed to providing exceptional service to clients, administrators, vendors and internal BAH resources.
    • Responsible for the departmental Clinical Risk and Medical cost management of high dollar claimant treatment(s) throughout the life cycle of the policy. Work with internal as well as external stakeholders to produce an effective clinical and financial outcome.  
    • Ensures the team operation is efficient and effective with responsibility for departmental oversight of review of claim notices, case management/trigger reports, claims and verbal communications to identify cost savings opportunities.  
    • Responsible for oversight of departmental clinical research and analytical review.
    • Responsible for coaching and developing effective departmental communications regarding claim/financial projections and rationale to both internal/external clients.
    • Foster strong relationships with external clients (Policyholders, TPA’s, external CM’s) and internal BAH resources (UW’s, Claims, Account Managers) through individual credibility. Apply business acumen to communicate risk factors, resolve complex inquiries and develop recommendations for continuous improvement and alignment with overall BAH risk strategy
    • Provides for oversight of departmental transplant contracts and provide assistance as needed with Policyholder education, Center of Excellence and Access Agreements.
    • Monitors and evaluates the department and staff for continual improvement of the efficiency and effectiveness of the group and provide individuals with professional and personal growth, training and development. 
    • Utilizes operational metrics and reports to track trend and results adjusting workflows accordingly.
    • Participates in the development and communication of internal policies, procedures and systems utilization.
    • Supports technological and vendor initiatives for the enhancement and efficiency of the clinical cost containment process.
    • Participates in new client implementation, industry meetings, product development and enhancement.

    Qualifications

    • BA/BS Degree required with a preference in Nursing or related field. Three (3) or more years of either Clinical- Health Risk/Stop Loss/Reinsurance experience.
    • Requires current unrestricted license as a Registered nurse,
    • Technical proficiency within Stop Loss and/or Managed Care products with a minimum of One - Three (1-3) years progressively responsible clinical management experience preferred.
    • Preferred to have at least two of the following : Advanced Achievement in Transplant Management (AATMC), Certification in Case Management (CCM),  Certified Rehabilitation Registered Nurse (CRRN), or Certified Professional in Utilization Management (CPUM) or American Association of Managed Care Nurses (AAMCN)
    • Autonomous Nursing leadership experience. Ability to work in a self-directed manner, and initiating and prioritizing regular work duties and projects. Ability to think analytically, critically and problem solve with ability to demonstrate decision-making skills and develop strategic plans.
    • Exposure to multiple and complex Stop Loss clinical issues with demonstrated experience in generating, selecting and implementing solutions to resolve those issues.
    • Detail oriented, organized, the ability to multi-task, and strong time management skills with the ability to meet deadlines and respond to unexpected requests in a prompt manner.
    • Proven ability to train and motivate employees. Develop, communicate and implement departmental and individual staff goals. Demonstrated ability and willingness to give candid and meaningful feedback.
    • Ability to professionally represent and present BAH with both small and large group presentation skills
    • Strong communication skills : written, verbal, interpersonal, customer service
    • Solid mathematical skills, strong computer skills, proficient in PC environment with MS Word, Excel and Outlook.
    • Solid negotiation skills, confidentiality, discretion and tact being key skills.
    • Ability to manage conflict comfortably and effectively, while being open minded to change and new ideas.
    • Exemplify solid work ethic and positive attitude regarding working relationships with management and staff to further the BAH mission.
    • Ability to work professionally and effectively with co-workers, clients, claimants, vendors and others with whom BAH does business
    • Maintain regular and predictable attendance with demonstrated ability to adapt to cyclical business needs
    • Ability to travel 5 - 10  %
    •  

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