Utilization Review Manager - Home Care jobs in Philadelphia, PA

Bring your drive for excellence, team orientation and customer commitment to Independence Blue Cross; help us renew and reimagine our business and shape the future of health care.  Our organization is looking to diversify, grow, innovate and serve, and we are looking for committed, empowered learning-oriented people to join our team.  If this describes you, we want to speak with you.

Clinical Customer Information Consultant (CIC) role is a member of the Informatics Team who provides clinical and data trend insights to customers in medical utilization meetings. While this role is aligned to our Informatics department, we have a specific need for experts in the clinical field with knowledge of health conditions and to understand optimal health journeys and drivers of medical spend. The CIC is also a key internal contributor to strategic discussions with our sales, product and marketing teams to support renewals, buy-ups or new business opportunities. 

• Present customer reporting data and analytics to external customers through executive presentations.
• Understand industry trends in medical management and claims utilization and incorporate and align industry trends to specific customer presentations
• Identify areas where customer utilization data can support cost/benefit ratios for buy-up products and opportunities
• Through analysis, reporting, and evaluation of benefit plan performance, work with our business partners in product to develop reporting for new products or support sales of new product offerings
• Partner with other departments in the organization and leadership teams to identify requirements and establish priorities based on the overall corporate strategy
• Develop and maintain a consultative partnership with internal customers (e.g. Underwriting, Clinical Services, Sales and Marketing, and Operations)
• Develop and maintain a consultative partnership with external customers (e.g. employer groups, brokers and consultants)
• Provide input into ad hoc reporting and analysis for specific customer needs
• Provide support to enhance web-based capabilities by defining the market needs and requirements for data and information
• Provide consultation on corporate data requirements and the development and integration of new systems and data sources needed for customer reporting
• Performs other duties as assigned

Qualifications:

• Bachelor’s degree in health services, nursing or related field of equivalent experience.
• Minimum of 8 years progressively increasingly responsible experience in the health care analytic environment, with a minimum of 3 years management experience.
• Demonstrated ability to interact effectively with all levels of an organization.
• Excellent organization, analytical, interpersonal, written and verbal communication skills.
• Excellent presentation skills
• Demonstrated experience in developing and maintaining budgets, policies, process and capacity plans
• Healthcare Insurance industry business knowledge preferred.