RN Field Case Manager

Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm's business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs. We're proud to be recognized again! For the fourth year in a row, we've been certified by Great Place to Work, and for the third consecutive year, we've earned a spot on Fortune's Best Workplaces in Health Care list . These honors reflect our unwavering commitment to fostering a positive, inclusive, and employee-centric culture where people thrive. Watch this short video for a brief introduction to role of a nurse case manager at Paradigm. Paradigm is hiring a Clinical Referral Manager for a remote, full-time, benefited position. The Clinical Referral Manager provides clinical support for the Catastrophic Referral Intake Unit. The schedule for this position is Monday through Friday, 8 AM to 5 PM Pacific time (9 AM to 6 PM Mountain time, 10 AM to 7 PM Central time, or 11 AM to 8 PM Eastern time). Responsibilities: Assist with assignment of the Primary Medical Team and Network Managers to new referrals. Evaluate incoming and existing referrals to determine appropriate product placement based on specified criteria. Assist the Catastrophic Referral Intake Unit in reviewing new referral escalations for appropriate product placement. Assess clinical conditions, treatment plans, and required resources. Escalate referrals that need additional or advanced services. Identify key stakeholders and responsible parties for each referral. Build and maintain strong relationships with stakeholders to ensure effective handling of catastrophic referrals. Provide education and support to customers regarding Paradigm products and services. Review active field case management files to identify opportunities for conversion to risk-bearing products. Analyze referrals that were unstaffed or withdrawn, gather relevant data, and provide insights to the sales team for potential conversion. Develop strategies to increase the scope of referrals considered for conversion and collaborate with other business units to implement these processes. Track and maintain data on referral conversions, including revenue and cases that were not successfully converted. Qualifications:

EDUCATION & EXPERIENCE REQUIRED:

Registered Nurse (with active, unencumbered license) Minimum of 3-5 years' experience in catastrophic case management, referral intake or sales Experience in insurance preferred. Demonstrated ability to define, manage and modify operational processes and workflows. Demonstrated ability to work collaboratively to address operational and customer requests. Intermediate to advanced level computer experience and Windows software, proficient in Microsoft product suite with advanced skills in Excel.

KNOWLEDGE SKILLS & ABILITIES:

Exceptional critical-thinking and creative problem-solving skills with proven ability to collaborate with others to identify alternatives and drive to resolution. Strong communication and facilitation skills including the ability to resolve issues and build consensus among groups of diverse internal/external stakeholders; Ability to deliver effective presentations to internal and external customers. Ability to work effectively autonomously and/or in a matrixed environment; Ability to be flexible and responsive to change. Excellent interpersonal skills with an ability to influence and lead through change. Ability to review and assess complex medical records and convey pertinent information to non-medical stakeholders Experience working as a Network Manager and using EDDG preferred Health and wellness We want our people to be and stay healthy, so we offer PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only). Financial incentives - Paradigm's financial benefits help prepare you for the future: competitive salaries, 401(k) matching contributions, employer-paid life and disability insurance, flexible spending, and employer-matched HSA contributions. Vacation - We believe strongly that work-life balance is good for you and for our company. We offer paid time off, paid holidays, and a personal holiday. Volunteer Time - We want our employees to engage with and give back to their communities in meaningful ways. Full and part-time employees receive one paid day per calendar year. Learning and development - One of Paradigm's core values is expertise, so we encourage our employees to continually learn and grow. We support this in a variety of ways through our LEAP training program. Description Req Number: Req #1944 Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm's business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs. We're proud to be recognized again! For the fourth year in a row, we've been certified by Great Place to Work, and for the third consecutive year, we've earned a spot on Fortune's Best Workplaces in Health Care list . These honors reflect our unwavering commitment to fostering a positive, inclusive, and employee-centric culture where people thrive. The Surprising Truth About Case Management - Paradigm Watch this short video for a brief introduction to role of a nurse case manager at Paradigm. Paradigm is hiring a Clinical Referral Manager for a remote, full-time, benefited position. The Clinical Referral Manager provides clinical support for the Catastrophic Referral Intake Unit. The schedule for this position is Monday through Friday, 8 AM to 5 PM Pacific time (9 AM to 6 PM Mountain time, 10 AM to 7 PM Central time, or 11 AM to 8 PM Eastern time). Responsibilities: Assist with assignment of the Primary Medical Team and Network Managers to new referrals. Evaluate incoming and existing referrals to determine appropriate product placement based on specified criteria. Assist the Catastrophic Referral Intake Unit in reviewing new referral escalations for appropriate product placement. Assess clinical conditions, treatment plans, and required resources. Escalate referrals that need additional or advanced services. Identify key stakeholders and responsible parties for each referral. Build and maintain strong relationships with stakeholders to ensure effective handling of catastrophic referrals. Provide education and support to customers regarding Paradigm products and services. Review active field case management files to identify opportunities for conversion to risk-bearing products. Analyze referrals that were unstaffed or withdrawn, gather relevant data, and provide insights to the sales team for potential conversion. Develop strategies to increase the scope of referrals considered for conversion and collaborate with other business units to implement these processes. Track and maintain data on referral conversions, including revenue and cases that were not successfully converted. Qualifications:

EDUCATION & EXPERIENCE REQUIRED:

Registered Nurse (with active, unencumbered license) Minimum of 3-5 years' experience in catastrophic case management, referral intake or sales Experience in insurance preferred. Demonstrated ability to define, manage and modify operational processes and workflows. Demonstrated ability to work collaboratively to address operational and customer requests. Intermediate to advanced level computer experience and Windows software, proficient in Microsoft product suite with advanced skills in Excel.

KNOWLEDGE SKILLS & ABILITIES:

Exceptional critical-thinking and creative problem-solving skills with proven ability to collaborate with others to identify alternatives and drive to resolution. Strong communication and facilitation skills including the ability to resolve issues and build consensus among groups of diverse internal/external stakeholders; Ability to deliver effective presentations to internal and external customers. Ability to work effectively autonomously and/or in a matrixed environment; Ability to be flexible and responsive to change. Excellent interpersonal skills with an ability to influence and lead through change. Ability to review and assess complex medical records and convey pertinent information to non-medical stakeholders Experience working as a Network Manager and using EDDG preferred Health and wellness We want our people to be and stay healthy, so we offer PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only). Financial incentives - Paradigm's financial benefits help prepare you for the future: competitive salaries, 401(k) matching contributions, employer-paid life and disability insurance, flexible spending, and employer-matched HSA contributions. Vacation - We believe strongly that work-life balance is good for you and for our company. We offer paid time off, paid holidays, and a personal holiday. Volunteer Time - We want our employees to engage with and give back to their communities in meaningful ways. Full and part-time employees receive one paid day per calendar year. Learning and development - One of Paradigm's core values is expertise, so we encourage our employees to continually learn and grow. We support this in a variety of ways through our LEAP training program. Paradigm believes that fostering a diverse and inclusive workplace is central to our mission of helping more people and transforming lives. We're striving to build a culture that better reflects the society we live in and empowers our team to deliver the highest levels of compassion and care to those we serve. For us, achieving this goal requires a workforce that respectfully embraces differences and commits to positive change, creating an environment where everyone is able to bring their whole self to work. Paradigm complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Leave Management at View email address on click.appcast.io. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. As a contractor with the State of Wisconsin, Paradigm complies with Wisconsin Contract Compliance Law (§16.765). Poster link: Contract Compliance Law Poster #J-18808-Ljbffr Association of California Nurse Leaders