Clinical Care Advocate II

Provides a detailed comprehensive review of injury event, to provide recommendations to direct medical management and coordination of services, utilizing evidence-based medicine, account criteria, state jurisdictional requirements ensuring the care they receive is the best from both a cost and medical outcome perspective.

Actively engaged with Claims Adjusters and Case Managers for movement of file, to identify issues, obstacles and implement strategies for resolution.

Can encompass working as a return-to-work coordinator within client specific guidelines; coordinates and maintains outcomes of claim file reviews; coordinates and maintains outcomes of complex claim reviews; reviews and provides outcomes of reviews of take-over claims; works with analytics on various projects to enhance outcomes and client experience.


* Individuals must hold a current, registered nurse professional license without restrictions to practice as a health professional in a state or territory of the United States.


* Associates degree in Nursing, Bachelor's degree in Nursing preferred.


* Individuals must hold a current, nationally recognized certification (CCM, CRRN, COHC, CRC) without restrictions to practice in the United States.


* Minimum of two years Case Management experience preferred


* Minimum eight years of clinical experience preferably in a varied clinical environment preferred


* Minimum two years as a CCAI or Sr Case Manager preferred


* Expertise in analytical problem solving, decision making with sound judgment, well organized with time management skills and excellent oral and written communication skills.


* Must possess a working knowledge of computers with the ability to use standard word processing, excel, and software applications.


* Effectively utilizes desktop tools to conform with State jurisdictional guidelines and account specific criteria.


* Exhibits a proven knowledge of multiple product lines and Services.


* Subject matter expert on Broadspire's medical management services.


* Demonstrates a proficiency in State Jurisdictional Guidelines and Account Specific criteria as applicable.


* Individuals who conduct initial clinical review possess a current, professional license or certification:
+ To practice as a health professional in a state or territory of the U.S.; and
+ With a scope of practice that is relevant to the clinical area(s) addressed in the initial clinical review.


* Must be able to travel as required.

#LI-RG1


* Addition to the skill set in Clinical Care Advocate I, the Clinical Care Advocate II position expands the scope of the nursing practice to include:


* Assessment
+ Initially reviews injury event, clinical documentation, treatment plan notated in the claim notes, identifying all issues and obstacles.
+ Review new takeover claims identified for clients, maintains excel spreadsheets for Account Executive and Client...