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About the role
Key responsibilities & impact- Own a book of business strategically
- Review internal dashboards, data files and benefit administrator reporting to evaluate clinical program performance
- Identify cases at risk for high costs in a timely manner
- Evaluate member and provider engagement in case management
- Review clinical interventions supporting care coordination and outcomes
- Report results to clients
- Communicate Mercer's perspective on clinical management strategies for potential and actual high-cost claimants
- Interpret benefit administrator reporting to drive performance improvement actions and select HCC cases for review
- Lead discussions with benefit administrators' clinical teams about case-management strengths and opportunities
- Engage Mercer multidisciplinary consultants to support oversight of HCC cases
- Draft clinical case-review reports and track trends for continuous process improvement
- Present summary reports to client representatives with insights and next steps
- Follow up with benefit administrators on recommendations
- Incorporate compliance and professional standards, including transparency, peer review and licensure maintenance
- Monitor project success regarding client satisfaction, scope, budget and delivery timeliness
- Establish carrier and vendor relationships
- Mentor and coach team members
- Assist with other consulting projects as needed
Requirements
What you’ll need- AD/BS degree required with an active unencumbered RN license
- At least 5–8 years of relevant work experience in clinical consulting or clinical carrier-related roles, including quality assurance, clinical auditing or clinical leadership
- Knowledge of MS Office tools, including Word, Excel, PowerPoint and Teams
- Proven project management skills
- Strong verbal and written skills
- Strong clinical acumen
- Ability to establish and execute strategic plans using creative problem-solving and clinical data and metrics
- Ability to prioritize and handle multiple tasks in a demanding work environment
- Ability to partner with and lead teams to produce client deliverables
- Ability to work independently and on a team
- Master's level degree in a related field preferred
- Case manager certification preferred
- Prior experience or knowledge of HCC management preferred
Benefits
Comp & perks- Opportunity to work with experienced industry professionals who provide coaching and development
- Dynamic, collaborative, inclusive culture
- Business Resource Groups, including PRIDE, Women@Mercer, Racial & Ethnic Diversity, AccessABILITIES and Rising Professionals Network
- Paid time off to volunteer through Mercer Cares
- Virtual learning and development resources
- Compensation and competitive rewards
- Retirement savings and 401K programs
- Stock purchase plan
- Health and welfare benefits
- Tuition assistance
- Employee assistance programs supporting physical, mental and financial wellbeing
- Hybrid work flexibility