Clinical Services Assistant Manager

About the role

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.

Responsibilities

• 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.

Requirements

• 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

Qualifications

• 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
• Able 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

Skills

• 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
• Able 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

Benefits

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/careers. Our employment practices are in accordance with the laws that prohibit discrimination due to race, color, creed, sex, sexual orientation, gender identity, genetic information, religion, age, national origin or ancestry, physical or mental disability, medical condition, veteran status, active military status, citizenship status, marital status or any other consideration made unlawful by federal, state, or local laws. All of our locations are tobacco free including in company vehicles.