Note: The job is a remote job and is open to candidates in USA. EMC Insurance Companies is focused on making an impact through teamwork and collaboration. As the Clinical Services Assistant Manager, you will lead a team of clinical experts and enhance claim outcomes through operational leadership and medical expertise.
Responsibilities
- Lead daily clinical services operations, including nurse case management, pharmacy, nurse review, and bill review functions
- Evaluate referrals and claim complexity, assigning work to internal staff or vendor partners
- Manage team workload, priorities, turnaround times, and overall service delivery
- Ensure clinical services are effectively integrated into claims handling processes and partner closely with claim professionals
- Lead, coach, develop, and monitor the performance of the Clinical Services team
- Oversee operational reporting, recommend KPIs, and monitor vendor performance and outcomes
- Partner with Claims leadership to expand clinical services, improve consultation practices, and enhance service quality
- Support implementation of new tools, clinical programs, regulatory changes, and vendor solutions
- Identify training needs, develop educational programs, and promote clinical services throughout the organization
- Drive process improvement initiatives that enhance efficiency, quality, and claim outcomes
Skills
- Current Registered Nurse (RN) license
- Eight years of nursing experience, including at least four years of property and casualty clinical claim oversight
- Advanced knowledge of casualty insurance, medical analysis and research
- Excellent written, verbal and interpersonal skills
- Strong working knowledge of personal computers and software systems
- Excellent organizational, management, and problem-solving abilities
- Ability to work on multiple tasks while meeting deadlines
- Ability to interpret and administer policies and procedures
- Excellent skills in conflict resolution and project coordination
- Ability to maintain a high level of confidentiality
- Bachelor's degree in nursing (BSN) preferred
- Legal Nurse Consultant Certified (LNCC) designation, Case Management (CM), or other applicable designations preferred
- Experience in multiple medical specialties preferred
- Previous leadership or supervisory experience preferred
Benefits
- For information relating to the benefits EMC Team Members receive as part of a comprehensive rewards package, please visit www.emcins.com/careers.
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