Clinical Consultant - RN at PartnerRe

Maple Grove, Minnesota, United States -

Full Time

Start Date

Immediate

Expiry Date

22 Jan, 26

Salary

117000.0

Posted On

24 Oct, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Expertise, Risk Management, Client Education, Claims Review, Data Analysis, Relationship Management, Cost Management, Transplant Management, Oncology Knowledge, Infusion Experience, NICU Experience, Communication Skills, Organizational Skills, Microsoft Excel, Microsoft Access, Microsoft Word

Industry

Insurance

Description

Company Description PartnerRe is a leading, privately owned, multi-line global reinsurer with a reputation of financial stability and strength, and a commitment to rebuilding businesses and communities after risk events around the world. Our mission is to continue to be a financially stable and predictable business partner, supporting our clients with solutions tailored to their needs, delivering superior returns to our owner, providing rewarding opportunities for our people and making a positive contribution to society. To achieve this, we live by our values of Integrity, Performance, Collaboration, Straightforward Communication and Respect and Care. Core to The PartnerRe Experience is our global nature. No matter where you sit in the company, you are part of something bigger. Our teams represent our truly international mindset, forging connections across office locations and all levels of the organization and building a network of mutual success. The result is a day-to-day experience that will allow you to: Shape your own career Grow in a supportive environment Connect with a community of experts Make an impact View Home - PartnerRe Experience e-book to find out more about what it’s like to work at PartnerRe. We are always looking for bright, proactive individuals to join our team! Please follow our Careers page for all updates on new positions. We look forward to receiving your application. PartnerRe is an equal opportunities employer. Please join our company LinkedIn Page for all updates on new positions that are coming live. At PartnerRe, we are committed to supporting the professional growth and well-being of our employees. In addition to a competitive salary, paid time off and eligibility for an annual incentive, we offer a comprehensive benefits package designed to support your physical and mental health, learning and development goals, and lifestyle needs. These include: Competitive Benefits Our benefits package includes comprehensive health, dental, and vision insurance for our employees and their dependents. We also offer wellness programs to promote a balanced and healthy lifestyle. Financial Security Plan for your future with our competitive retirement savings plans, including a 401(k) retirement plan. Additionally, we provide life insurance and disability coverage to protect you and your loved ones. Professional Development We are committed to supporting your growth and development. Take advantage of our educational assistance programs for Accounting and Actuarial professionals and our comprehensive L&D offerings to expand your skills and achieve your professional goals. Additional Perks Enjoy a range of additional perks such as on-site amenities, social events, Employee Resource Groups, a robust Referral Program and more. Compensation: Salary Range: $78,000 - $117,000 Bonus: 10% Target Job Description About this job: PartnerRe Health, the global Health Division of PartnerRe, is an acknowledged leader in providing risk management solutions to accident and health markets. The PartnerRe team of experienced professionals develops innovative, client-specific solutions by thoroughly understanding our clients’ goals, market, risk tolerance and exposures. Using a suite of proven proprietary financial and analytical tools, an effective risk management program is designed with extensive support services. 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 solutions Transplant center of excellence networks and contract evaluation Proactive approach to managing quality and cost of care Board-certified specialty physician panel, with physician-driven consultation services Comprehensive analytical auditing services; hospital and physician claim audits Top-tier primary and supplemental PPO networks with supplemental contract negotiations Specialty pharmacy management and network Advocacy for supplemental payers Educational support and webinars About 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 case Collaborate 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. Notify key stakeholders of cases that breach our reinsurance layer. Notify 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. Stay on top of current high risk market trends, specialty drugs and gene and cellular therapies through research and conference attendance. Qualifications About you: Computer Skills Must be proficient in Microsoft programs including but not limited to Excel, Access, Outlook and Word. Must be able to learn other software programs required by the department. Education and/or Experience Registered Nurse (RN) with MN Board of Nursing. Bachelor’s degree in nursing, or Associates degree with comparable experience 5+ clinical experience is required 1-3 years of insurance or reinsurance industry experience is preferred Transplant/Oncology or Infusion experience is preferred NICU experience (Transplant, oncology, NICU or infusion experience is preferred) Commission for Case Management Certification (CCM) is preferred Other Skills and Abilities Must have or be able to quickly acquire knowledge of departmental program structure (mission, goals and objectives), department policies and procedures. Must have a sound knowledge and ability in business correspondence and an ability to proofread for grammar, spelling and punctuation with a high degree of accuracy. Must be able to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rates, obtain ratios and percentages and to draw and interpret bar graphs. Must maintain professional and technical expertise through participation in continuing education as necessary. Ability to handle multiple interruptions and adjustments to priorities throughout the day. Ability to communicate effectively with diverse individuals and to calmly and efficiently handle situations ranging from routine to urgent. Excellent memory and organizational ability, in order to set priorities, organize workload, handle multiple responsibilities and meet deadlines. Proficient on standard office equipment including personal computer, multi-line telephone system, fax machine, copier, scanner. Personal attributes / Common culture: Serves our stakeholders with purpose, successfully and efficiently Lives our values in all we do Sets the standard by which customers and competitors judge themselves Raises the bar for ourselves, on behalf of our clients Represents the highest level of professionalism in our industry; embodying honesty, integrity, maturity and appropriateness Respects and honors each employee as a valued member of our team Fosters a unified team spirit where we all work for the success of each individual Maximizes the strengths and minimizes the weaknesses of our employees Motivates, trains and develops its people personally and professionally; calling them to share and participate in our Mission, Values, Vision and Goals Sustains an environment of direct and respectful communication Provides new creative solutions for the needs of our clients Addresses value migration proactively and with vigor Reinvents itself, continually — thriving in a state of disequilibrium Cannibalizes our own products and services to create new trends and solutions (rather than react to current ones), in anticipation of changes in the broader accident and health market Is led by a Management Team that, with unity and purpose, is intentionally building something that will survive them Additional Information #LI-Hybrid PartnerRe provides a working environment in which diversity is valued, where all employees feel welcome, respected, and empowered to perform at their best. We invite you to learn more about D&I at PartnerRe. Thank you, PartnerRe Hiring Team PartnerRe provides a working environment in which diversity is valued, where all employees feel welcome, respected, and empowered to perform at their best. We invite you to learn more about D&I at PartnerRe. Thank you, PartnerRe Hiring Team

Responsibilities

The PULSE Clinical Consultant serves as a risk manager, collaborating with clients to address complex medical reimbursement issues. They provide clinical expertise to ensure effective management of healthcare risks and optimal outcomes.