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Clinical Case Manager

2 months ago

Canada MSH Americas - Diot-Siaci Group Full time
About Us

We are a leading healthcare organization dedicated to delivering exceptional patient care and innovative solutions. Our team is passionate about making a positive impact on people's lives around the world.

About the Role

We are seeking an experienced Clinical Case Manager to join our team. As a key member of our healthcare team, you will be responsible for managing a large caseload, providing expert medical opinion, and ensuring compliance with all procedures and processes.

Key Responsibilities
  • Medically validate cases and determine the necessity and/or eligibility of services for all cases assigned for medical review
  • Provide expert medical opinion regarding medical necessity, length of stay, and reasonable and customary charges for a given medical service
  • Comply with all procedures and processes established for all medical teams of the Siaci Group
  • Review and release of high claims including notifications for high dollar cases with the establishment of reserves and appropriate followup
  • Monitor high-cost pharmacy expenses
  • Participate in new projects as needed
  • Summarize medical information in a clear and concise manner
  • Weekly rounds or case notification reporting to clients
  • Facilitate commercial or medevac repatriations
  • Effectively communicate and document all interactions in the appropriate platform depending on the line of business concerned
  • Be available for rotational shifts on days, evenings, nights, weekends, and statutory holidays
  • Participate in an on-call rotation servicing clients outside of standard business hours
Requirements
  • RN, RPN, or unlicensed MD (Canada) from another country
  • Minimum 3 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
Preferred Qualifications
  • 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)
What We Offer
  • Hybrid work environment
  • Excellent health benefits
  • Employee assistance program
  • Wellness account
  • RRSP matching
  • Minimum 3 weeks' vacation
  • Generous allowances for sick and flex days
  • Tuition reimbursement program
  • Opportunities to learn new skills, grow, and move into different roles
  • A work environment that embraces diversity and promotes inclusivity
  • Supportive leadership prioritizes your success and cares about your wellbeing
  • A growth trajectory that is designed to expand both vertically and horizontally, providing you with opportunities to pursue your passions and acquire new skills

MSH Americas is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other protected status under applicable law.