As the Clinical Services Assistant Manager, you'll lead a team of clinical experts and serve as a key partner to Claims, helping deliver better claim outcomes through medical expertise, consultation, and operational leadership. You'll oversee clinical services operations, develop team capabilities, drive process improvements, and expand the impact of clinical resources across the organization. This role is ideal for a clinical leader who enjoys developing people, influencing business decisions, improving processes, and leveraging their nursing and claims expertise to make a meaningful organizational impact.
Essential Functions: - 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.
Education & Experience:- Current Registered Nurse (RN) license
- Bachelor's degree in nursing (BSN) preferred
- Eight years of nursing experience, including at least four years of property and casualty clinical claim oversight
- 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
Knowledge, Skills & Abilities:- 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
The hiring salary range for this position will vary based on geographic location, falling within either of the following:$100,085 - $138,285 or $110,624 - $152,122
A hiring range represents a subset of the full salary range. The actual salary will depend on several factors, including relevant education, skills, and experience of an applicant, geographic location, and business needs.For information relating to the benefits EMC Team Members receive as part of a comprehensive rewards package, please visit www.emcins.com/careersAll of our locations are tobacco free including in company vehicles.
