Nurse, Health Consultant

• Work on implementing strategic Health Management projects across a portfolio of clients to control medical plan costs and promote a culture of health promotion within companies.
• Monitor hospitalization authorization codes to track ongoing admissions and propose strategies for early discharge/de-hospitalization.
• Participate in the health committees of key clients to analyze the main risks related to the medical policy and to monitor implemented health actions.
• Conduct health studies, mapping major deviations and their financial impacts to prioritize key risks and define an action plan based on the findings.
• Address technical queries received from clients (analysis of medical claim denials, ROL coverage, facilitating medical transfers with the insurer).
• Discuss medical cases with the clinical/medical teams of our clients.

Requirements

• Degree in Nursing with active COREN registration (Regional Nursing Council).
• Intermediate knowledge of Microsoft Office (particularly intermediate Excel and PowerPoint).
• Experience in the health benefits market, medical auditing, brokerages, and health plan operators.
• Analytical and clinical-care perspective.
• Strategic thinking.
• Experience developing health indicators/KPIs.
• Ability to work effectively in a team.
• Conflict resolution skills.
• Good communication skills.