Senior Clinical Disenrollment Specialist

The Senior Clinician reports directly to the Clinical Manager and is responsible for providing first level support to a team of clinicians (SWs/RNs/LPNs).
The primary functions are to assist the clinicians by answering questions, offering guidance, and providing deskside refresher training.
Whilethis position does not have managerial responsibilities, they support the effectiveness and productivity of the team as a subject matter expert and a first level resource for escalated issues.
This position is also responsible for being an early adopter of change efforts to provide feedback and support the change effort and adoption by other team members.Conducts standard duties and responsibilities of a clinician (Care Manager/ Case Manager/ Clinical Specialist)Assists the clinicians by walking the virtual floor and assisting Managers in resolving inquiries.Assists the Manager in monitoring logs of open/closed cases to ensure all are handled appropriately and in a timely manner.Takes responsibility for complex cases.Collaborates with the team to provide input on training to new clinicians.Handles a caseload and works with leadership to test and incorporate new changes and process approachesProvide quality oversight in conjunction with Manager; monitoring and coaching to the clinicians to enhance quality and member satisfaction.Participates in and assists management with the testing and roll out of interdepartmental campaigns.Participates in quality and performance improvement projects, acting as a liaison with management and clinicians as workflow improvements are implemented.Comply with HIPAA guidelines and maintain confidentiality of member, provider, medical and departmental information.
Adhere to state and federal compliance and regulatory guidelines.Identify trends and recommend process improvements.Lead team refresher training, as needed, in collaboration with Managers.Build sustainable relationships of trust through open and interactive communication with internal and external customers.Multi-task, prioritize, and manage time effectively.Additional duties as assigned.Minimum Qualifications:
At least two years experience in Care Manager/ Case Manager/ Clinical Specialist roleConsistently meets or exceeds current work expectations, applicable metrics, and quality standards set by leadershipDemonstrates verbal and written communication skillsExperience handling complex situations and/or projectsProficient in Microsoft Office Suite applications including Excel, Word, Power Point, and Outlook.Preferred Qualifications:
Experience with TruCare and/or other similar electronic health record systemsUnderstanding of government programs and federal/state guidelines related to utilization management.Bachelors Degree from an accredited institutionWorking experience using MS Excel to sort, copy and paste, as well as experience creating and using pivot tables.Frequently communicates complex information and interacts with management.
Can present, resolve conflicts, and address delicate situations.Positively drives team cultureAbility to work flexible hours, weekends, and evenings due to business needs.Compliance & Regulatory Responsibilities:
See AboveLicense/Certification:
RN or SW preferredWE ARE AN EQUAL OPPORTUNITY EMPLOYER.
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Healthfirst will never ask you for money during the recruitment or onboarding process.Hiring Range
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Greater New York City Area (NY, NJ, CT residents):
$81,099 - $116,480All Other Locations (within approved locations):
$71,594 - $106,080As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements).
Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
• The hiring range is defined as the lowest and highest salaries that Healthfirst in good faith would pay to a new hire, or for a job promotion, or transfer into this role.