RN Clinical Referral Manager - Workers Compensation

About the role

Paradigm is hiring a Clinical Referral Manager for a remote, full-time, benefited position. The Clinical Referral Manager provides clinical support for the Catastrophic Referral Intake Unit. The schedule for this position is Monday through Friday, 8 AM to 5 PM Pacific time (9 AM to 6 PM Mountain time, 10 AM to 7 PM Central time, or 11 AM to 8 PM Eastern time).

Responsibilities

• Assist with assignment of the Primary Medical Team and Network Managers to new referrals.
• Evaluate incoming and existing referrals to determine appropriate product placement based on specified criteria.
• Assist the Catastrophic Referral Intake Unit in reviewing new referral escalations for appropriate product placement.
• Assess clinical conditions, treatment plans, and required resources. Escalate referrals that need additional or advanced services.
• Identify key stakeholders and responsible parties for each referral. Build and maintain strong relationships with stakeholders to ensure effective handling of catastrophic referrals.
• Provide education and support to customers regarding Paradigm products and services.
• Review active field case management files to identify opportunities for conversion to risk-bearing products.
• Analyze referrals that were unstaffed or withdrawn, gather relevant data, and provide insights to the sales team for potential conversion.
• Develop strategies to increase the scope of referrals considered for conversion and collaborate with other business units to implement these processes.
• Track and maintain data on referral conversions, including revenue and cases that were not successfully converted.

Qualifications

Education & experience required:

• Registered Nurse (with active, unencumbered license)
• Minimum of 3-5 years' experience in catastrophic case management, referral intake or sales
• Experience in insurance preferred.
• Demonstrated ability to define, manage and modify operational processes and workflows.
• Demonstrated ability to work collaboratively to address operational and customer requests.
• Intermediate to advanced level computer experience and Windows software, proficient in Microsoft product suite with advanced skills in Excel.

Knowledge, skills & abilities:

• Exceptional critical-thinking and creative problem-solving skills with proven ability to collaborate with others to identify alternatives and drive to resolution.
• Strong communication and facilitation skills including the ability to resolve issues and build consensus among groups of diverse internal/external stakeholders; Ability to deliver effective presentations to internal and external customers.
• Ability to work effectively autonomously and/or in a matrixed environment; Ability to be flexible and responsive to change.
• Excellent interpersonal skills with an ability to influence and lead through change.
• Ability to review and assess complex medical records and convey pertinent information to non-medical stakeholders
• Experience working as a Network Manager and using EDDG preferred

Benefits

• Health and wellness – We want our people to be and stay healthy, so we offer PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only).
• Financial incentives – Paradigm's financial benefits help prepare you for the future: competitive salaries, 401(k) matching contributions, employer-paid life and disability insurance, flexible spending, and employer-matched HSA contributions.
• Vacation – We believe strongly that work-life balance is good for you and for our company. We offer paid time off, paid holidays, and a personal holiday.
• Volunteer Time – We want our employees to engage with and give back to their communities in meaningful ways. Full and part-time employees receive one paid day per calendar year.
• Learning and development – One of Paradigm's core values is expertise, so we encourage our employees to continually learn and grow. We support this in a variety of ways through our LEAP training program.