Senior Clinical Consultant - RN

About this job:PartnerRe’s PULSE + Plus™ Medical Management Program is an integrated, state-of-the-art program that partners with our clients to proactively manage healthcare risk exposures and find optimal solutions for evolving healthcare challenges. PULSE + Plus™ Medical Management helps optimize both clinical and financial outcomes through a wide range of value-creating services that enhance risk protection at multiple levels. Program features include:Rare, complex and chronic disease management and network solutionsTransplant center of excellence networks and contract evaluationProactive approach to managing quality and cost of careBoard-certified specialty physician panel, with physician-driven consultation servicesComprehensive analytical auditing services; hospital and physician claim auditsTop-tier primary and supplemental PPO networks with supplemental contract negotiationsSpecialty pharmacy management and networkAdvocacy for supplemental payersEducational support and webinarsAbout the role:The PULSE Clinical Consultant role is to serve as risk managers, working closely with our clients internal stakeholders to educate, validate, collaborate and solve complex and costly medical reimbursement issues.  As clinical experts, our clinical consultants are able to identify and understand a clients’ risk profile, educate on how to more effectively manage that risk and work with a variety of specialty service providers to generate optimal outcomes both clinically and financially.  They provide clinical expertise to PartnerRe’s underwriting and claims departments to ensure insightful administration of PartnerRe Health’s products.   JOB DUTIES  The following reflects management’s definition of essential functions for this position but does not restrict the responsibilities that may be assigned.  Management may assign or reassign duties and responsibilities to this job at any time due to reasonable accommodation or other reasons.Develop relationships with assigned clients and producers. Review assorted claims, trigger reports, and 50% notice reports to identify catastrophic diagnoses or cases of concern for intervention.Obtain additional medical or financial information from the client, if there are outstanding questions on a member’s caseCollaborate closely with claims team and underwriters, providing a seamless and integrated client experience.Understand nuances of each line of business and adjust activities and interventions based on the uniqueness of each market segment.Educate clients to better understand risk and how to manage it.Leverage opportunities to insert cost management services to reduce risk.Manage relationships with specialty service providers as appropriate.Assist underwriting teams in underwriting and disclosure reviews.Perform clinical claim reviews.Identify, notify and provide regular updates to management of cases exceeding a specific threshold into our layer.Escalate cases of concern as outlined in our standard operating procedures.Implement new clients regarding PULSE + Plus™ services.Analyze transplant contracts with our various networks to select optimal contract.Deliver appropriate information and documents to client and/or producer following implementation.Create and maintain client profiles in PULSE + Plus™ database.Document and maintain records of medical management services selected by each client. Track medical management interventions and savings by client and prepare savings reports for clients and brokers.Independent in work function and master’s annual performance objectives.Subject matter expert with responsibility for one or more major areas (pharma, transplant, gene/cell therapy, bill review, oncology)Ability to consistently meet deadlines.Act and respond with a sense of urgencyA mentor to others team members. Specifically, this would be a proficient to expert level team member able to mentor other members of the team at the novice, beginner, advanced beginner or competent level.  Willingly seeks opportunities to mentor other team members to broaden knowledge on entire team without being asked or directed.Independently seek out opportunities to drive improvements on the team.