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Clinical Case Manager
2 months ago
We are a leading healthcare organization dedicated to delivering exceptional patient care and services. Our team is comprised of experienced professionals who share a passion for making a positive impact on people's lives.
We are seeking a highly skilled Clinical Case Manager to join our team. As a key member of our healthcare team, you will be responsible for managing complex medical cases and providing expert guidance to our case managers, intake specialists, and claims examiners.
About the Role:The Clinical Case Manager will be the primary point of contact for our specialized case and claims management team, requiring both medical and non-medical expertise. You will be responsible for medically validating cases, determining the necessity and eligibility of services, and providing expert medical opinion regarding medical necessity, length of stay, and reasonable and customary charges.
You will also be responsible for reviewing and releasing high claims, monitoring high-cost pharmacy expenses, and participating in new projects as needed. Additionally, you will be required to summarize medical information in a clear and concise manner, facilitate commercial or medevac repatriations, and effectively communicate and document all interactions in the appropriate platform.
What We Offer:- A hybrid work environment that promotes work-life balance
- Excellent health benefits, including medical, dental, and vision coverage
- An employee assistance program to support your mental health and wellbeing
- A wellness account to promote healthy habits and self-care
- RRSP matching to support your retirement savings
- A minimum of three weeks' vacation to recharge and relax
- Generous allowances for sick and flex days to ensure your health and wellbeing
- Tuition reimbursement program to support your professional development
- Opportunities to learn new skills, grow, and move into different roles within the organization
- A work environment that values diversity, inclusivity, and respect
- RN, RPN, or unlicensed MD (Canada) from another country
- Minimum three years of experience as a case manager
- Customer service experience
- Excellent verbal and written communication skills in English
- Superior time management skills
- Resourcefulness
- Ability to communicate diplomatically
- Ability to work in a fast-paced and dynamic environment
- Intermediate level of experience in Microsoft Office Suite
- Excellent English verbal and written communication skills
- Ability to work well both independently and as part of a team
- Critical thinking and decision-making skills
- Prior experience managing cases for an international patient program
- Previous experience in travel, major medical, or expat insurance within a TPA environment
- Preference will be given to those speaking a third language (German, French, Spanish, Italian, Mandarin, etc)
- Rotational shifts may be required to satisfy business operational needs, including days and evenings, and holidays
- Overtime may be required on an occasional basis
- On-call rotation may be required at least one week every month
