At Luminare Health, our people are what set us apart. Their expertise, dedication, and passion for service excellence are the foundation of our success.
We're committed to helping our employees grow through thoughtful development opportunities, meaningful work, and a culture that values collaboration and continuous improvement. When you join Luminare Health, you join a purpose-driven team focused on making healthcare simpler, better, and more affordable.
The Clinical Advisor is responsible for providing day to day client support on behalf of the Health Care Management department. Under the direction of the Senior Director, Clinical Consultant, the primary responsibilities will be to support our members and clients day to day and strategically collaborate with all Healthcare Management and non-Healthcare Management team members to ensure the needs of our clients are met. The Clinical Advisor will strategically collaborate with these teams to ensure our current workflows and processes for Utilization Review and Case Management meet the needs of new and existing clients. The position will have additional responsibility to have active visible presence with internal and external (client facing) clients for management and support for our business needs and growth. The Clinician Advisor will support the Senior Director, Clinical Consultant by maintaining active communication and relationships with all internal and external stake holders in sales, clinical teams, client management, claims, managed care, etc. to deliver solutions and results for our business.
Support and implement appropriate clinical related products, services and initiatives to include developing workflows and processes.
Partner with HCM operational units and client management teams to ensure client needs are clearly understood, and implemented support those needs.
Develop, implement, and document procedures and standards that ensure the delivery of results that satisfy high standards of quality, compliance, and timeliness for our internal and external clients.
Assist HCM teams by providing analysis of current medical/claims trends, HCM pre-authorization option list as well as market demands and deliver results to client’s as necessary.
Collaborate with all HCM and Non-HCM areas to ensure timely, accurate and pertinent information flows between HCM and non-HCM areas. To include as appropriate, representing HCM across service lines to ensure operational needs and concerns are being met and working in collaboration with client management and HCM Operations to ensure client issues are being responded to in a timely fashion.
Identify opportunities for improved quality assurance measures and participate in development and testing of those measures as appropriate
Contributes to the development, maintenance, and revision of department policies and procedures as appropriate.
Review and identify areas in need of improved efficiency. Provide enhancement recommendations and participate in planning and testing of those solutions.
Serves as a clinical resource for sales and client management for new and existing client needs
Regularly attend client meetings as requested by Client and/or Client Management team as a Clinical Representation. This could be virtually or in person as needed.
Assist in pulling client specific reports and providing clinical analysis and summary to clients for Case Management, Utilization Management and any other clinical trends.
Provide details and specific feedback to prospective and existing client’s questions regarding all aspects of Healthcare Management Clinical Programs
Assist in the development of client’s Prior Authorization Lists for cost mitigation for the plans
Maintains current basic knowledge Intake Team, Utilization Management and the Case Management Process.
Serves as a Clinical Resource to support the Client Management Team, Healthcare Management Department’s Utilization Management, Case Management and Administrative Services teams.
Prioritizes daily work assignment to meet division goals and customer requirements.
Participates in Quality Improvement initiatives as appropriate.
Other duties as assigned and needed
Travel as required for client meetings
Required Job Qualifications:
Education:
Associate Degree
Active State Registered Nursing License
Experience
Minimum five years’ experience in direct clinical care and/ or
Minimum of three years’ experience in medical management including case management or utilization management
Minimum 1 year in healthcare consulting (client facing role or experience in delivery of results to clients)
Knowledge of Health Care, Industry and Managed Care Delivery systems. This includes current standards of medical practice, insurance benefit structure, related legal/medical issues, utilization management, case management and quality management processes.
General Abilities/Competencies:
Ability to actively manage and delivery on client expectations around projects, timelines, deliverables, outcomes, etc.
Experience working with all levels within a client organization
Excellent oral, written and presentation communication skills with the ability to interact effectively with new and existing clients and other internal clients (ie: claims, client management, senior leadership, etc.)Evaluate problems, develop alternative solutions and identify trends and patterns.
Deal with problems involving several concrete variables in standardized situation.
Ability to prioritize efforts when faced with tight deadlines and multiple, complex projects
Strong organizational skills with attention to detail
A demonstrated ability to adapt, quickly learn new skills and serve as a sponsor of change
Maintain high level of confidentiality, flexibility and willingness to learn new tasks and take on new duties as needed
Critical thinking skills allowing one to carry out instruction furnished in written, oral or diagram form
A demonstrated ability to think/work/prioritize independently
Work in a dynamic team-oriented environment
Write/create routine correspondence and reports
Read and interpret documents, criteria, instructions, and policy and procedure manuals.
Ability to travel as needed.
Demonstrates knowledge of Microsoft Office Suite products.
Preferred Job Qualifications:
Bachelor of Science in Nursing
Prior Utilization Management and/or Case Management experience
TPA or Health Insurance related experience
Personnel management experience a plus
Strong consultative and analytical skills
Location: This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.
Required Job Qualifications:
Education:
- Associate Degree
- Active State Registered Nursing License
Experience
- Minimum five years’ experience in direct clinical care and/ or
- Minimum of three years’ experience in medical management including case management or utilization management
- Minimum 1 year in healthcare consulting (client facing role or experience in delivery of results to clients)
- Knowledge of Health Care, Industry and Managed Care Delivery systems. This includes current standards of medical practice, insurance benefit structure, related legal/medical issues, utilization management, case management and quality management processes.
General Abilities/Competencies:
- Ability to actively manage and delivery on client expectations around projects, timelines, deliverables, outcomes, etc.
- Experience working with all levels within a client organization
- Excellent oral, written and presentation communication skills with the ability to interact effectively with new and existing clients and other internal clients (ie: claims, client management, senior leadership, etc.)Evaluate problems, develop alternative solutions and identify trends and patterns.
- Deal with problems involving several concrete variables in standardized situation.
- Ability to prioritize efforts when faced with tight deadlines and multiple, complex projects
- Strong organizational skills with attention to detail
- A demonstrated ability to adapt, quickly learn new skills and serve as a sponsor of change
- Maintain high level of confidentiality, flexibility and willingness to learn new tasks and take on new duties as needed
- Critical thinking skills allowing one to carry out instruction furnished in written, oral or diagram form
- A demonstrated ability to think/work/prioritize independently
- Work in a dynamic team-oriented environment
- Write/create routine correspondence and reports
- Read and interpret documents, criteria, instructions, and policy and procedure manuals.
- Ability to travel as needed.
- Demonstrates knowledge of Microsoft Office Suite products.
Preferred Job Qualifications:
- Bachelor of Science in Nursing
- Prior Utilization Management and/or Case Management experience
- TPA or Health Insurance related experience
- Personnel management experience a plus
- Strong consultative and analytical skills
Location: This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii .
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
Pay Transparency Statement:
At Luminare, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for associates .
The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.
Min to Max Range:
$67,600.00 - $127,000.00
Exact compensation may vary based on skills, experience, and location.
