318 clinical consultant jobs found

Are you a registered nurse who is passionate about helping individuals achieve optimal recovery and return-to-work outcomes? Guardian is seeking an RN Clinical Consultant to serve as a clinical expert supporting the evaluation of short-term and long-term disability claims. In this role, you will analyze medical information, assess functional capacity, collaborate with healthcare providers, and provide clinical guidance that supports claim decisions. You will play a critical role in enhancing customer outcomes through sound clinical judgment, proactive case collaboration, and a commitment to exceptional service. You are A highly motivated and clinically skilled registered nurse who thrives in a fast-paced, customer-focused environment. You can work independently while also collaborating effectively with claim professionals, healthcare providers,...

When you join the team at Unum, you become part of an organization committed to helping you thrive. Here, we work to provide the employee benefits and service solutions that enable employees at our client companies to thrive throughout life’s moments. And this starts with ensuring that every one of our team members enjoys opportunities to succeed both professionally and personally. To enable this, we provide:  Award-winning culture  Inclusion and diversity as a priority  Performance Based Incentive Plans Competitive benefits package that includes: Health, Vision, Dental, Short & Long-Term Disability  Generous PTO (including paid time to volunteer!)  Up to 9.5% 401(k) employer contribution  Mental health support  Career advancement opportunities  Student loan repayment options  Tuition reimbursement Flexible work environments  *All the benefits listed above are subject to the terms of their individual Plans. And that’s just...

Foundation Risk Partners , one of the fastest growing insurance brokerage and consulting firms in the US, is adding a Clinical Account Manager to their  ARMSRx team .  Job Summary: Serve as a trusted clinical advisor for ARMSRx pharmacy benefit consulting clients. This role combines clinical expertise, strategic consulting, analytics, and relationship management to help clients optimize pharmacy benefits, improve member outcomes, manage pharmacy spend, assess PBM performance, and evaluate emerging market developments. Essential Functions: Serve as the primary clinical consultant for an assigned portfolio of clients and broker partners. Build trusted relationships with client stakeholders and participate in client meetings, strategic reviews, and quarterly business reviews. Provide recommendations related to formulary management, specialty pharmacy, utilization management, benefit design, and emerging pharmacy trends. Translate complex clinical...

A career at Auto-Owners is challenging and rewarding.  Our group of caring associates create financial security by helping individuals and businesses make a new start when a loss occurs. Job Description We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, this specific role could have the flexibility to work from home up to 3 days per week. Auto-Owners Insurance, a top-rated insurance carrier, is seeking motivated nursing professional to join our team. The position requires the person to: Use the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the claimant’s health across the care continuum. Coordinate care delivery and support among claimant support systems, including providers, community-based agencies, and family Collaborate with claims associates to provide medical expertise in the investigation, evaluation, and appropriate resolution of...

Responsible for the retention and growth of existing and assigned accounts in support of organizational strategic, financial and performance goals by executing on core sales and business development activities such as strategic account/agency planning, sales consultations, identification of sales opportunities, and renewal support. Responsible for managing local accounts through agency or consultant interfacing Develop, refresh, and execute multi-year strategic account/agency plans to grow and retain the account and relationships, including identifying key opportunities, risks, and mitigation strategies. Present internal strategic account/agency plans to leadership team as well as external plans to accounts or agencies/consultants for review and alignment. Leverage strategic account/agency plans to drive annual strategic discussions and other strategic planning efforts with accounts. Deliver account specific advice on plan benefit design,...

AffirmedRx is on a mission to improve health care outcomes by bringing clarity, integrity, and trust to pharmacy benefit management. We are committed to making pharmacy benefits easy to understand, straightforward to access and always in the best interest of employers and the lives they impact . We accomplish this by bringing total clarity to business practices, leading with clinical approaches, and utilizing state-of-the-art technology.   Join us in improving health care outcomes for all!  We promise to do what’s right, always.   Position Summary:   The Director of Client Executives leads and develops the team of Client Executives who own the strategic relationship, contract economics, and renewal outcomes for AffirmedRx's largest, most complex, and highest-value health plan clients. Operating within AffirmedRx's dual-ownership model for strategic accounts, this director-level leader sets direction for the account-ownership...

SUMMARY   The Senior Nurse Case Manager (SNCM) role within the Claims Department is to assist management and the claims team in supporting strategic initiatives and achieving annual claims goals. This position is responsible for applying medical knowledge in reviewing complex workers’ compensation claims to determine causal nature of patient’s symptoms, medical necessity/reasonableness of treatment, facilitate claimants’ return to work (RTW) and propose alternative care arrangements.  SNCM assists in development of new medical cost containment programs and projects as well as taking a leadership role in the implementation and ongoing support of these initiatives. The SNCM utilizes competence, positive communication skills, problem solving and conflict resolution techniques. The SNCM demonstrates strong organization and time management skills with the ability to affect change when necessary. This role may execute their essential functions telephonically or as a Field NCM...

SUMMARY   The Senior Nurse Case Manager (SNCM) role within the Claims Department is to assist management and the claims team in supporting strategic initiatives and achieving annual claims goals. This position is responsible for applying medical knowledge in reviewing complex workers’ compensation claims to determine causal nature of patient’s symptoms, medical necessity/reasonableness of treatment, facilitate claimants’ return to work (RTW) and propose alternative care arrangements.  SNCM assists in development of new medical cost containment programs and projects as well as taking a leadership role in the implementation and ongoing support of these initiatives. The SNCM utilizes competence, positive communication skills, problem solving and conflict resolution techniques. The SNCM demonstrates strong organization and time management skills with the ability to affect change when necessary. This role may execute their essential functions telephonically or as a Field NCM...

SUMMARY   The Senior Nurse Case Manager (SNCM) role within the Claims Department is to assist management and the claims team in supporting strategic initiatives and achieving annual claims goals. This position is responsible for applying medical knowledge in reviewing complex workers’ compensation claims to determine causal nature of patient’s symptoms, medical necessity/reasonableness of treatment, facilitate claimants’ return to work (RTW) and propose alternative care arrangements.  SNCM assists in development of new medical cost containment programs and projects as well as taking a leadership role in the implementation and ongoing support of these initiatives. The SNCM utilizes competence, positive communication skills, problem solving and conflict resolution techniques. The SNCM demonstrates strong organization and time management skills with the ability to affect change when necessary. This role may execute their essential functions telephonically or as a Field NCM...

                     Responsible for the retention and growth of existing and assigned accounts in support of organizational strategic, financial and performance goals by executing on core sales and business development activities such as strategic account/agency planning, sales consultations, identification of sales opportunities, and renewal support. Responsible for managing local accounts through agency or consultant interfacing Develop, refresh, and execute multi-year strategic account/agency plans to grow and retain the account and relationships, including identifying key opportunities, risks, and mitigation strategies. Present internal strategic account/agency plans to leadership team as well as external plans to accounts or agencies/consultants for review and alignment. Leverage strategic account/agency plans to drive annual strategic discussions and other strategic planning efforts with accounts. Deliver account specific advice on plan benefit design,...

The position is described below. If you want to apply, click the Apply button at the top or bottom of this page. You'll be required to create an account or sign in to an existing one. If you have a disability and need assistance with the application, you can request a reasonable accommodation. Send an email to Accessibility (accommodation requests only; other inquiries won't receive a response). Regular or Temporary: Regular Language Fluency:  English (Required) Work Shift: 1st Shift (United States of America) Please review the following job description: Drive sales growth and maintain strong client relationships with employee benefit brokers and consultants, stop loss carriers, and various clinical point solutions providers. Responsible for understanding client’s needs, assessing risk profiles, and recommending tailored solutions to protect their financial interests.  This is role is remote; however, it will require travel and in person meetings...

Job Description: We are looking to add a Financial Consultant to join our Employee Benefits team in Dallas, TX . Offering a forward-thinking, innovative, and vibrant company culture, along with the opportunity to share your unique potential, there really is no place like Holmes! Essential Responsibilities: Provides Financial/Clinical consulting to clients with respect to their employee benefit health and welfare plans; Responsible for presenting financial/clinical data to clients. Runs and Analyzes client monthly financial reporting (MFSR) and presents MFSRs to clients. Provides complex reporting, presenting results to clients. Participates in development of financial reporting enhancements. Assists in development of new CLUE reporting. Takes prominent role in the development and enhancements of new and existing client budget, financial and clinical analysis and tools. Builds and maintains Financial/Clinical models to support client account teams;...

The Claims Consultant supports the administration and processing of pharmacy benefit claims for self-funded employer health plans. This role serves as a key liaison between clients, plan members, pharmacies, pharmacy benefit managers (PBMs), third-party administrators (TPAs), and internal teams to ensure claims are processed accurately, efficiently, and in accordance with plan provisions and regulatory requirements. The Claims Consultant plays a critical role in analyzing claim issues, resolving discrepancies, identifying cost-saving opportunities, and delivering exceptional service to clients and stakeholders. This position contributes directly to ARORx's mission of helping self-funded organizations optimize pharmacy benefits, manage costs, and improve plan performance. Responsibilities: • Review, investigate, and resolve pharmacy benefit claim issues and inquiries in a timely manner. • Analyze claim adjudication outcomes and identify discrepancies, processing errors, and...

AffirmedRx is on a mission to improve health care outcomes by bringing clarity, integrity, and trust to pharmacy benefit management. We are committed to making pharmacy benefits easy to understand, straightforward to access and always in the best interest of employers and the lives they impact. We accomplish this by bringing total clarity to business practices, leading with clinical approaches, and utilizing state-of-the-art technology. Join us in improving health care outcomes for all!  We promise to do what’s right, always. Position Summary: The VP of Strategic Growth is responsible for driving revenue growth and market expansion by executing AffirmedRx’s sales strategy. This role focuses on managing and strengthening regional broker and consultant relationships and direct to employer relationships to generate new business opportunities.  Additionally, the position oversees the RFP process from initial discussions to finalist presentations, ensuring smooth...

A career at Auto-Owners is challenging and rewarding.  Our group of caring associates create financial security by helping individuals and businesses make a new start when a loss occurs. Job Description We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, this specific role could have the flexibility to work from home up to 3 days per week. Auto-Owners Insurance, a top-rated insurance carrier, is seeking motivated nursing professional to join our team. The position requires the person to: ·        Collaborate with claims associates to provide medical expertise in the investigation, evaluation, and appropriate resolution of injury claims including workers’ compensation, personal injury protection (no fault), and liability. ·        Evaluate medical records for relatedness to the injury and appropriate utilization of medical treatment and services. ·        Prepare and deliver trainings to claims...

The Role: Willis Towers Watson is looking for an energetic individual with growth, pharmacy, clinical and client facing expertise to join our growing team. As a Pharmacy Consultant, Manager you will be at the forefront of managing pharmacy benefits projects for clients and leverage your experience as a pharmacy benefits expert to make recommendations on plan design and management. You will participate in new business activities and the creation of new intellectual capital.  You will position yourself to grow into a senior relationship management and/or leadership role by serving as the subject matter expert on pharmacy projects and working alongside industry experts on cutting edge solutions. The ideal candidate is a patient-centric problem solver who possesses the ability to balance client clinical needs and business growth. You will collaborate with a strong team of highly experienced consultants within the practice as well as engage in cross-functional activities. A...

We’re excited you’re considering joining a great place to work!  Texas Mutual is deeply committed to creating and maintaining an environment of mutual respect and is proud to be an equal opportunity employer. All qualified applicants are encouraged to apply and will receive consideration for employment without regard to age, race, color, national origin, religion, sex, gender identity, sexual orientation, genetic information, veteran status, or any other basis protected by local, state, or federal law. About this Position We're looking for a Provider Relations Consultant to serve as a senior-level subject matter expert within our workers' compensation provider network. If you're a strategic, relationship-driven professional with deep knowledge of workers' compensation managed care, we want to hear from you. Responsibilities & Qualifications What You'll Do Manage complex, high-profile provider relationships including large occupational health systems and...

Foundation Risk Partners , one of the fastest growing insurance brokerage and consulting firms in the US, is adding a Clinical Risk Management Consultant to their  Cornell Insurance Services  team in the Edison, NJ office.  Job Summary: The Clinical Risk Management Consultant is focused on identifying, assessing, and mitigating clinical risks for healthcare providers within an insurance brokerage firm, utilizing their medical expertise to analyze potential claims, advise clients on risk reduction strategies, and work with underwriters to secure appropriate coverage based on clinical risk factors.  Essential Functions: Clinical Risk Assessment: Review medical records, incident reports, and claims data to identify potential clinical risks associated with patient care, including medication errors, standard of care compliance risks, and diagnostic errors. Detect and manage risk exposure Maintain and update an organization's policies...

Job Description: We are looking to add a Financial Consultant to join our EB team in Minneapolis, MN . Offering a forward-thinking, innovative, and vibrant company culture, along with the opportunity to share your unique potential, there really is no place like Holmes! Essential Responsibilities: Runs and analyzes client monthly financial reporting (MFSR) and presents MFSRs to clients. Provides intermediate-level financial reporting and presents results to clients. Works independently and/or under senior team member's guidance to assist with client budget modeling as needed. Recommends basic strategic and tactical initiatives based upon clinical and financial data. Analyzes IBNR results with senior team member oversight. Attends client meetings with occasional day and overnight travel required. Articulates how emerging market conditions impact client health and welfare plans from a cost and clinical perspective. Articulates employee benefit...

Quality Auditors Are Integral Members Of Our Account Management Teams Who Proactively Obtain, Compile And Follow Up On Information Critical To Providing Exceptional Consulting, Placement And Advocacy For Willis Tower Watson Clients And Prospects. You Will Be Required To Work Monday – Friday From 9:00 Am – 6:00 Pm. Note That Visa Employment-Based Non-Immigrant Visa Sponsorship And/Or Assistance Is Not Offered For This Specific Job Opportunity. The Role In This Role You Will Be Responsible For Auditing All Transactions That Are Processed In The Surety Service Center. You Will Be Responsible For Maintaining A High Level Of Accuracy And A Strong Knowledge Of Surety Bond Transactions. This Will Involve Building Relationships And Working Closely With Client-Decision Makers, Reviewing Executed Deliverables On Our Client’s Behalf In Accordance With Our Service Level Agreements And Standard Operating Procedures And Completing Various Administrative Tasks. You Must Also Be Able To...