RN Case Management and Utilization Account Manager - Midtown New York

Get To Know Us!

WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans.

Job Details

• Ability to work hours: Monday to Friday 8:00am - 5:00pm and as needed
• Location: New York City, New York (Midtown vicinity)

What is your impact?

The Clinical Account Executive (CAE) is a strategic leadership role responsible for overseeing and managing large, complex client relationships and driving long-term success for strategic and large market/strategic accounts. The CAE focuses on delivering exceptional client experiences by aligning business strategies with client objectives, fostering innovation, and ensuring high-value outcomes. The CAE is responsible for engaging with account/client on a regular basis through scheduled meetings and reporting efforts; Providing direct, efficient, and effective clinical analysis of group-specific cost drivers and trends with identification of actionable opportunities and solutions targeted at existing and prospective cost drivers; assist with clinical portion of escalated issues that may arise on client accounts. The CAE will work closely with the WebTPA Account Management or other Administrator teams to ensure that strategic partnerships are well-managed, ensuring superior service levels and overall retention of the business.

What Will You Be Doing:

Client Support and Issue Resolution:

• Develop and maintain a thorough understanding of client objectives for their benefits plan, as it relates to the clinical components of the plan.
• Maintain knowledge of the client performance indicators that the clinical team will be responsible for and held accountable too.
• Recommend/model changes necessary to achieve objectives within the clinical teams.
• Responsible for daily evaluation of account reporting/needs and implementation processes or staffing to support specific account
  requirements.
• Responsible for problem resolution with escalation to the Sr. Director as appropriate.
• Collaborate with clinical staff as an initial resource escalating to Account Management and POD when necessary.
• Respond to client inquiries within 24 business hours - acknowledge and build expectations for resolution and deliver on commitments.
• Understand what clinical programs each client has purchased and how that client wants to utilize the programs to address their specific areas of interest and focus.
  Leverage problem-solving skills and frameworks to develop solutions to client's business problems.
• Assist clients and internal teams in addressing escalated issues related to clinical areas.

Data Analysis:

• Measure and monitor daily account metrics with appropriate interventions.
  Access and navigate various technical platforms and systems that are affiliated with the clinical division and client management: iiiPUT, clinical documentation platforms, various applications used by clients, through outside vendors.
• Validate, analyze, interpret client data to make effective cost, quality, and shared decision-making recommendations resulting in increased client satisfaction and retention.
• Conduct clinical analysis and provide input to customized evaluations which includes identification, interpretation, and communication of overall account performance against benchmarks and clinical trends, with specific recommendations to improve performance and outcomes.
• Work with the internal reporting/analytics team to prepare external client reports.

Client Reporting:

• Deliver external presentations to clients that demonstrate the value of products, programs, and processes, as well as build an ongoing relationship with internal teams at Communitas and WebTPA.
• Work with the Director to represent the Clinical division during client calls, meetings (remote or onsite), and presentations.

Collaboration with WebTPA/Communitas teams and external vendors:

• Facilitates timely and open communication with clinical staff departments, internal and external customers.
• Work collaboratively and cross-functionally with internal and external teams.
  - Daily interventions between Operation and Clinical teams to ensure proper handling of claims issues / customer service requests / member portal requests; that they are assigned to Ops team to assist and resolve when appropriate.
  - Assist CAM with higher-level decisions that impact outside teams.
• Engage with internal clinical teams and provide feedback from clients to clinical teams.
  Work with clinical teams leads to analyze, identify, and improve processes within the division, based on client feedback.
• Develop strong, trusting relationships with assigned groups, agents, consultants, and brokers for continued client retention.

What You Must Have:

• 7+ years related work experience
• Supervisory/management experience
• Associate's or Bachelor's degree in Nursing
• Current RN license in state of New York
• Demonstrated proficiency in all MS Office applications including Word, Excel, Access and PowerPoint.
• Strong verbal and written communication skills. Writing samples may be requested as proof.
• Ability to present to clients and executives in a confident manner.
  Negotiation skills.
• Superior client service attitude coupled with excessive energy and enthusiasm.
• Extremely driven with the ability to self-manage.
• High attention to details; particularly those driving benefit plan performance.
• Ability to work independently/autonomously and proactively as well as collaboratively as a member of a team.
• Analysis - ability to identify problems/issues and propose high-performing solutions.
• Ability to segment and prioritize workload based on time sensitivities and critical success factors.
• Well-developed project management skills.

What We Prefer:

• CCM - Certified Case Manager
• Previous Managerial/Director-level experience in healthcare setting preferred.
• Previous experience with Regulatory Compliance and/or URAC/NCQA Accreditation is beneficial.
  

What We Can Offer YOU!

To support your wellbeing, comprehensive benefits are offered. As a WebTPA employee, you will have access to:

• Medical, dental, vision, life and global travel health insurance
• Income protection benefits: life insurance, Short- and long-term disability programs
• Leave programs to support personal circumstances
• Retirement Savings Plan includes employer contribution and employer match
• Paid time off, volunteer time off, and 11 holidays
• Additional voluntary benefits available and a comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for interns and part-time employees may differ.

Typical Annualized Hiring Range: $89,800-$112,300

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

Physical/Environmental Activities
Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Frequently

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.