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Clinical Services Assistant Manager
EMC Insurance CompaniesClinical Services Assistant Manager leading a team of clinical experts for Claims operations. Overseeing clinical services, driving process improvements, and promoting clinical resources within the organization.
About the role
Key responsibilities & impact- 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.
Requirements
What you’ll need- 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
Benefits
Comp & perks- Health insurance
- 401(k) matching
- Competitive paid time off plan
- Full day of volunteer time off annually
- Financial incentives including pension plan and bonus plan
- Professional development and growth opportunities including tuition reimbursement
- Wellness initiatives to improve team member well-being and reduce health insurance costs
- Flexibility to dress for your day and opportunities for alternative work arrangements
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Nurse Case ManagementPharmacy ManagementBill Review FunctionsOperational ReportingKPI DevelopmentClaims Handling IntegrationClinical Program ImplementationVendor Performance MonitoringTraining Program DevelopmentConsultation Practices
Soft Skills
Team LeadershipCoachingPerformance MonitoringCollaborationCommunication
Certifications
Legal Nurse Consultant Certified (LNCC)Case Management (CM)