Clinical Case Management - SME

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

Job title:

Job Description:

Education:

• Bachelor’s Degree in Nursing

Experience:

• 2 year post-education clinical experience (Premium PA, EHE Coaching, CPAN, PNA, TCM, IPCM, PC, & PCM only)
• 2 year post-education clinical experience (CHIL)

Mandatory Skills:
With Moderate Competency Level in the ff.:

• US Healthcare Delivery System
• Philippine Healthcare Delivery System
• Communication Skills (Spoken)
• Communications Skills (Written)
• Customer Service Orientation
• Computer Literacy
• Job Knowledge
• Sense of Urgency
• Passion for Excellence
• Working in Team/Interpersonal Skills
• Work Organization
• People Management/Team Orientation
• Drive for Results/Execution
• Thriving in Change
• Expertise/Analytical Skills
• Product Knowledge
• Problem Solving
• Presentation Skills
• Facilitation Skills
• Coaching
• Process Improvement
• Performance Management
• Discipline Management

DUTIES & RESPONSIBILITIES:

• The Clinical SME provides expert clinical knowledge and support to various internal and external stakeholders. This includes answering clinical inquiries, providing educational materials, and assisting with the development and implementation of clinical guidelines.
• Provide expert guidance and information to internal teams (Operations, Training, BE and other enabling departments) regarding products, procedures, and Clinical guidelines.
• Create, review and deliver educational materials, such as Training programs, presentations, and online resources, to improve clinical knowledge and understanding.
• Supporting clinical activities, including but not limited to: Data collection, analysis, and reporting or facilitating trainings for the advocates.
• Work with cross-functional teams to ensure alignment and effective communication of clinical information.
• Establish and maintain strong relationships and connection with healthcare partners to build trust and ensure their needs are met.
• Address clinical issues/concerns, be able to provide solutions, and escalating complex cases as needed.
• Continuously learning and staying informed about the latest developments in clinical practice and healthcare technology.
• Assist with refresher session to calibrate and align on process updates
• Flexibility on work set up changes based on business needs or requirements. This may include but not limited to the following: Team Activity focusing on performance, cascade of process updates or clinical-related updates.

Work At Home Responsibilities

• Be familiar with and abide to all Sagility general security and Work @ Home security policies and procedures·      
• Be familiar with and abide by all client security policies and procedures required to protect customer data·      
• Maintain the security of the home work environment and protect the Sagility-provided assets, client system and data·      
• Ensure that all security related incidents are reported·      
• Shall work on the same internet connection that was tested during setup process. If changes are made to the current internet connection or router during the course of application or employment, employee will be required to notify the appropriate parties in advance and retest the connection to ensure the requirements are met.·      
• Must immediately report system performance problems or downtime to his/her manager and the local IT-SPOC·      
• Flexibility on Work set up changes in case that there are outages encountered to avoid work disruption  

General Safety and Security

• Protects the organization’s assets by upholding the principles of the Quality Information Security Management System (QISMS).·       Ensures confidentiality, integrity, and availability of information critical to fulfilling the organization’s business functions.·      
• Ensures compliance to relevant business, local and international regulatory and legislative requirements particularly the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Health Information Technology for Economic and Clinical Health Act (HITECH), and Utilization Review Accreditation Commission (URAC).·      
• Able to establish, implement and continuously improve the quality information security policies assigned to him / her.·      
• Able to establish structures and procedures to protect classified information.·      
• Able to report information security related incidents without any delay to the proper authorities'   Example: All information-related incidents, losses, weaknesses and software/ hardware malfunctions, breaches of confidentiality.·      
• Able to participate during training, orientation and awareness programs pertaining to QISMS. 

The above statements are intended to indicate the general nature and level of work being performed by employees within this classification. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of employees assigned to this job. Employees in this job may perform other duties as assigned.

Location: