Claims Consultant providing quality PAL claims consulting services to MMA Michigan clients. Responsibilities include claims management, client advocacy, and developing best practices in claims resolution.
About the role
- Senior Medical Consultant II developing Medicaid managed care strategies for Mercer. Collaborating on diverse projects while leading teams through planning and execution in a hybrid work environment.
Responsibilities
- Participate on multiple project teams as a subject matter expert in Medicaid and/or military health managed care programs and operations
- Coordinate and effectively support or manage project teams, ensuring the team is within budget, on time, and producing work consistent with the scope of the project
- Coordinate with clients and sector leaders to support development of new business, including contributing to the proposal process
- Stay current on market trends and the regulatory environment; consider the implication of new trends or changes in policies or regulations on clients’ programs
- Develop intellectual capital; take your best thinking and lead or participate in the development of tools or processes that can be leveraged for multiple clients
Requirements
- BA/BS degree required; master’s degree preferred
- Licensed Registered Nurse (RN) required (within continental U.S.)
- Minimum ten years of relevant experience required
- Managed care leadership experience in a clinical or quality role required
- Demonstrated critical thinking and analytical problem-solving skills
- Experience with HEDIS and other nationally recognized healthcare quality measures and External Quality Review processes and protocols
- Experience with clinical informatics and/or experience using and interpreting health care data to build better health programs
Benefits
- Health and welfare benefits
- Tuition assistance
- 401K savings
- Other retirement programs
- Employee assistance programs
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