Paradigm is hiring a Clinical Referral Manager for a remote, full-time, benefited position. The Clinical Referral Manager provides clinical support for the Catastrophic Referral Intake Unit. The schedule for this position is Monday through Friday, 8 AM to 5 PM Pacific time (9 AM to 6 PM Mountain time, 10 AM to 7 PM Central time, or 11 AM to 8 PM Eastern time).
Responsibilities:
- Assist with assignment of the Primary Medical Team and Network Managers to new referrals.
- Evaluate incoming and existing referrals to determine appropriate product placement based on specified criteria.
- Assist the Catastrophic Referral Intake Unit in reviewing new referral escalations for appropriate product placement.
- Assess clinical conditions, treatment plans, and required resources.
- Escalate referrals that need additional or advanced services.
- Identify key stakeholders and responsible parties for each referral.
- Build and maintain strong relationships with stakeholders to ensure effective handling of catastrophic referrals.
- Provide education and support to customers regarding Paradigm products and services.
- Review active field case management files to identify opportunities for conversion to risk-bearing products.
- Analyze referrals that were unstaffed or withdrawn, gather relevant data, and provide insights to the sales team for potential conversion.
- Develop strategies to increase the scope of referrals considered for conversion and collaborate with other business units to implement these processes.
- Track and maintain data on referral conversions, including revenue and cases that were not successfully converted.
Qualifications:
EDUCATION & EXPERIENCE REQUIRED:
- Registered Nurse (with active, unencumbered license)
- Minimum of 3-5 years’ experience in catastrophic case management, referral intake or sales
- Experience in insurance preferred
- Demonstrated ability to define, manage and modify operational processes and workflows
- Demonstrated ability to work collaboratively to address operational and customer requests
- Intermediate to advanced level computer experience and Windows software, proficient in Microsoft product suite with advanced skills in Excel
KNOWLEDGE SKILLS & ABILITIES:
- Exceptional critical-thinking and creative problem-solving skills with proven ability to collaborate with others to identify alternatives and drive to resolution
- Strong communication and facilitation skills including the ability to resolve issues and build consensus among groups of diverse internal/external stakeholders; Ability to deliver effective presentations to internal and external customers
- Ability to work effectively autonomously and/or in a matrixed environment; Ability to be flexible and responsive to change
- Excellent interpersonal skills with an ability to influence and lead through change
- Ability to review and assess complex medical records and convey pertinent information to non-medical stakeholders
- Experience working as a Network Manager and using EDDG preferred