Clinical Case Manager

2 days ago

Canada MSH Americas - Diot-Siaci Group Full time

About Us:

We are seeking ambitious individuals who share our values and our passion for making a positive impact on people's lives around the world. If you are looking for a career that challenges and inspires you, then you've come to the right place.


About You:

You are an experienced Medical Professional who can handle a large caseload, multitask, and meet tight deadlines. You thrive in a fast-paced, 24/7 team environment and will provide excellent customer service.


You will have the ability to demonstrate an in-depth understanding of the case management process and work well with other departments to troubleshoot and resolve issues should they arise. You must be willing to work rotational shifts including days, evenings, nights, weekends, and statutory holidays. You may also be part of an on-call rotation to handle situations outside of regular business hours.


The Clinical Case Manager will be the primary point of contact for a specialized case and claims management team requiring both medical and non-medical expertise. You will guide and provide direction to Case Managers, Intake Specialists, and Claims Examiners utilizing your clinical knowledge by performing medical reviews and validations for Claims.


The Clinical Case Manager will be responsible for the management of their caseload which entails medical management and cost containment principles for all our lines of business. The role may have an after-hours component that requires the Case Manager to be on-call for any calls and medical emergencies that may arise outside of standard business hours which will require immediate medical review and action.


In this role, you’ll get to experience:

  • Medically validate cases and determine the necessity and/or eligibility of services for all cases assigned for medical review
  • Provides expert medical opinion regarding medical necessity, length of stay, and reasonable and customary charges for a given medical service
  • Compliance 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 follow-up
  • Monitor high-cost pharmacy expenses
  • Participation 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
  • Other duties as assigned by the Director of Clinical Operations


What you bring:

  • 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


What do you need to succeed?

  • 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)


Additional Notes

  • If needed, a rotational shift to satisfy business operational needs including days and evenings is required including holidays. Overtime is required on an occasional basis.
  • If needed, on-call rotation is at least 1 week every month
  • A laptop is required and will be supplied


What’s in it for you:

  • 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 well-being.
  • 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 is an Equal Opportunity Employer

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. We encourage and welcome applicants from all backgrounds to apply for our open positions.

Removing obstacles to offer fair access to jobs is our top priority. When a candidate asks for reasonable accommodation throughout the application process, a Human Resources professional will assist them. The information provided during the accommodation request process will be handled, saved, and utilized by the laws that apply to it as well as the rules of MSH International.

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