Health Services/Case Management Consultant
Location: Minneapolis
Description: Reinsurance Group of America is hiring Health Services/Case Management Consultant right now, this career will be placed in Minnesota. Further informations about this career opportunity kindly read the description below. Reinsurance Group of America, Incorporated (NYSE: RGA) is one of the largest global providers of life reinsurance, with offices around the world. RGA delivers expert solutions in individual life reinsurance, individual living benefits reinsurance, group reinsurance, financial solutions, facultative underwriting and product development. Our mission is to enhance our clients’ prosperity by supporting their financial and risk management capabilities.
Since 1984, ROSE (Reinsurance Outcomes and Service Experts) is! the foremost consulting service program available in the rein! surance market today. As a Health Services Consultant, you will work directly with our reinsurance client companies and offer our innovative, value-added services that complement their medical case management programs and help manage catastrophic claims costs.
Under limited supervision, provide high quality case management and claims management consulting, including identification, assessment and management of high cost cases. The overall goal of the position is to assure cost effective claims management and promote client satisfaction and retention.
1. Ensure cost effective case management consultation services for high cost/frequency cases. Consult with clients on case management issues, alternative levels of care, program development, quality improvement and educational needs. 2. Ensure cost effective reinsurance claims management. Consult with clients on high cost claims management strategies. Establish reserves authorize claim payments, assist with au! dits, determine need for extra contractual agreements, and monitor clients’ claims activity. 3. Work with RGA underwriting, account management and claims staff to improve service to customers and manage the customer relationship. 4. Under limited supervision, communicate, market, and educate senior and middle management of current and prospective clients and brokers regarding program services available. Present appropriate information to prospective customers in sales presentations. 5. Report industry trends and assist with care and cost management strategies to reduce claim costs for clients and RGA. 6. Assist in the underwriting process with regard to evaluation of claims experience, future risk, and clients’ case and claims management capabilities. 7. Audit/review clients’ case management and claims management practices on a regular basis. Perform Operational Review (in-depth audit and formal report) of clients’ case management programs under supervision of Senio! r Health Services Consultant. 8. Review reinsurance treaty (contract) w! ording for clarity/administrative interpretation; evaluate clients’ current and future claims trends and provide recommendations to improve contract clarity. 9. Assist with planning and hosting the Annual ROSE Conference and bi-monthly teleconferences, including identifying topics and speakers, obtaining CEU credits and determining events. 10. Maintain regular and predictable attendance. 11. Other duties as assigned.
Job Requirements :
Required:
Bachelor’s Degree in Nursing/related field, with 5-7 years of experience, or Associate or Diploma Degree with 7-10 years of experience.
4-6 years case management experience.
Current Registered Nurse license and/or current CRRN, CIRS, CCM or CRC certification.
Knowledge and expertise in health care systems and practices.
Managed Care experience (either hospital or HMO/health insurance company).
Ability to be flexible when needed, take initiative, and demonstrate accountability. Intermediate oral and written communication skills demonstrating ability to share and impart knowledge.
Ability to quickly adapt to new methods, work under tight deadlines and stressful conditions.
Intermediate level of investigative, analytical and problem solving skills
Intermediate presentation skills
Ability to set goals and handle multiple tasks, clients, and projects simultaneously; Ability to appropriately balance priorities, deadlines, and deliverables
Ability to work well within a team environment and participate in department/team projects
Ability to balance detail with departmental goals/objectives
Ability to foster customer service as needed
Ability to translate business needs and problems into viable/accepted solutions
Expert negotiating, persuasion, and conflict resolution skills
General business knowledge including marketing, sales, and financial
Ability to travel 10-20%
Preferred:
Certified C! ase Manager
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If you were eligible to this career, pleas! e email us your resume, with salary requirements and a resume to Reinsurance Group of America.
If you interested on this career just click on the Apply button, you will be redirected to the official website
This career starts available on: Sun, 08 Dec 2013 14:05:07 GMT