Specialized Services Clinical Administrator

Professional Case Management; Northern (KY); Hybrid; USD 60,000 - 85,000; Full time

Benefits offered by this job

Medical

Dental

Vision

401(k)

Company Paid Short Term Disability

Flexible Spending Account (FSA)

Health Savings Account (HSA)

Paid Time Off

Voluntary Benefits

Job summary

Professional Case Management (PCM) is seeking a Registered Nurse to provide advisory support to a Specialized Services Physician for PCM Home Care clients. You will help write medical opinion letters and coordinate with clinicians, case managers, and claimants to ensure accurate documentation and timely processing.

This role requires strong communication, Salesforce documentation, and client education on benefits.

Qualifications

• Registered Nurse license and active practice.
• Knowledge of EEOICPA program and stakeholders.
• Strong verbal, written and interpersonal communication skills.
• Proficient computer skills and Salesforce experience.
• English proficiency in speaking, reading, and writing; written communication is important.

Responsibilities

• Advise Specialized Services Physician and assist in writing medical opinion letters for Home Care clients.
• Liaise with Clinical Operations, Home Care teams, physicians and Case Managers.
• Educate Home Care clients on benefits to added covered conditions.
• Document all steps in Salesforce and maintain claimant contact records.
• Guide clients through the DOL/EEOICPA processes and respond to claimant questions.

Skills

Verbal communication

Written communication

Interpersonal skills

Computer skills

English proficiency

Phone skills

Customer service

Team collaboration

Education

Registered Nurse

Tools

Salesforce

Job description

Put your talents to work at PCM! Whether you work in our Home Care, Clinical Research, Impairments, or Catastrophic Care division, you will support our mission to deliver care and other services that enhance the quality of life of our clients. Be a part of our dynamic client-focused team and make a difference in your career! Performs advisory activities to assist a Specialized Services Physician with all the tasks necessary to write medical opinion letters for PCM Home Care clients.

QUALIFICATIONS

• Registered Nurse
• Knowledge of the EEOICPA program and key stakeholders’ operating practices (e.g. DOL Resource Centers) is strongly preferred -.
• Demonstrates strong verbal, written and interpersonal communication skills.
• Strong computer skills.
• Speaks, reads, writes, and comprehends English.
• Written communication is particularly important in this role.
• Demonstrates time management, organizational skills, and ability to function with minimal direction.
• Experience with letter writing on behalf of claimants in the EEOICPA Program is highly desirable.
• Diligently maintains claimant contact records in Salesforce
• Extensive knowledge of conditions that are common to White Card holders/EEOICPA claimants.
• Offers subject matter expertise and creativity in helping claimants whose circumstances lie outside of established processes
• Utilize strong phone skills – this role requires extensive time on the phone, but is not considered a Call Center position
• Provide exceptional customer service to claimants
• Build strong relationships with team members, physicians, and Case Managers.

ESSENTIAL FUNCTIONS/AREAS OF ACCOUNTABILITY

• Liaising with PCM’s Clinical Operations and Home Care clients regarding prospective new conditions that can potentially be added to a client’s white card
• Write clinical summaries to assist the Specialized Services physician
• Educate Home Care clients on the benefits to them of adding new covered conditions
• Document all steps in Salesforce and update as applicable
• Work directly with clients and Case Managers to guide them through the DOL process
• Request records from treating physicians and providers in support of the claim
• Follow up with claimants at each step of their DOL authorization process to gauge progress and offer additional guidance
• Answer claimant questions regarding the DOL - processes and EEOICPA program and benefits

Individual base pay depends on various factors, in addition to primary work location, complexity and responsibility of role, job duties/requirements, and relevant experience, skills and other market-based factors.

Available Benefits

• Medical
• Dental
• Vision
• 401(k)
• Company Paid Short Term Disability
• Flexible Spending Account (FSA)
• Health Savings Account (HSA)
• Paid Time Off
• Voluntary Benefits

Professional Case Management is an Equal Opportunity Employer.

At Professional Case Management (PCM), our mission drives us. We have a growing team of over 4,000 employees who are passionate about delivering care that enhances the quality of life of clients in the most healing of environments – the home. We believe that aligning genuine, caring team members with this purpose is life-changing for our clients, customers, and teammates alike. And it’s our goal to consistently stretch ourselves – and the organization – to ensure we’re always learning, growing, and elevating our standards of service. In everything we do, we share a strong set of core values: We Work As A Team, We Do The Right Thing, We Figure It Out, We Pursue Growth, and We Take Ownership. PCM has been an industry leader in delivering specialized in-home care and other services to clients for over 30 years. Our Home Care division is the nation’s premier Home Healthcare provider to former nuclear weapons and uranium workers, upholding the highest standards of care through accreditation by the Accreditation Commission of Health Care (ACHC).