Job Description

Indulge your passion for problem-solving and embrace the thrill of addressing risk head-on at Gallagher's global brokerage team. Join a family of diverse minds, united by a relentless pursuit of excellence. As part of our team, you'll be the architect of protection, safeguarding businesses and empowering their ambitions. Together, we'll build a legacy of trust and triumph in the dynamic world of risk management.

We believe that every candidate brings something special to the table, including you! So, even if you feel that you’re close but not an exact match, we encourage you to apply.

The Nurse Navigator Manager is responsible for leading the Nurse Navigator (NN) team, driving strategic initiatives, and ensuring operational excellence. This role focuses on improving member engagement, cost savings, and clinical outcomes through effective team management, data analysis, and collaboration with internal and external stakeholders. The Nurse Navigator Manager will also oversee the development of workflows, ensure compliance with healthcare regulations, and act as a resource for clinical and operational excellence.

Team Leadership and Development:

• Lead and manage the Nurse Navigator team, including performance evaluations, staffing, and professional development.
• Design and implement training programs to support staff development and ensure operational excellence.
• Provide mentorship and guidance to Nurse Navigators in areas such as healthcare navigation, claims resolution, and prior authorization processes.

Data Analysis and Reporting:

• Oversee data analysis and reporting to support strategic initiatives by developing dashboards, metrics, and tracking processes to monitor key performance indicators (KPIs) such as member engagement, cost savings, task timeliness, and clinical outcomes.
• Collect and analyze data related to health outcomes, program participation, and satisfaction to assess program effectiveness and identify opportunities for improvement through data-driven recommendations.

Vendor and Partner Collaboration:

• Build and maintain strong relationships with strategic partners to enhance clinical oversight, reporting capabilities, and operational efficiency.
• Collaborate with healthcare professionals, vendors, and other departments to integrate health and wellness initiatives.

Strategic Initiatives:

• Lead initiatives to improve member engagement, preventative care, and cost savings through enhanced workflows, data visibility, and reporting capabilities.
• Advance strategies including: Site of Care Steerage, Rural vs. Metro cost analysis, Frequent ER User outreach, and others as deemed necessary.
• Develop and implement workflows for disease management, case management, and proactive outreach to high-risk members.

Case/Utilization Management Oversight:

• Provide oversight for case management processes to ensure timely resolution and effective team support.
• Ensure appropriate utilization of services and effective case/cost management.
• Monitor and resolve escalated large claims issues and ensure appropriate treatment and billing.
• Manage a small caseload of high-priority or high-complexity cases to maintain clinical expertise and provide direct support for critical member needs.
• Act as a resource for the team by demonstrating best practices in handling complex cases and ensuring alignment with organizational goals.

Compliance and Knowledge Management:

• Ensure team compliance with healthcare regulations, including HIPAA, DOL, and other applicable standards.
• Maintain knowledge of healthcare billing and reimbursement processes, managed care guidelines, and national standards of practice.
• Stay updated on industry trends and advancements in case management, utilization management, and healthcare navigation.

• Active Registered Nurse (RN) license required.
• Bachelor of Science in Nursing (BSN) preferred.
• Minimum of 5+ years of experience in a Case Management or Utilization Management environment.
• Proven management experience, including leading teams and driving performance.
• Demonstrated ability to develop and execute a strategic vision to achieve organizational goals.
• Strong analytical skills with experience in tracking and reporting on KPIs.
• Knowledge of healthcare billing and reimbursement processes, managed care guidelines, and national standards of practice.
• Proficiency in using claims management software and productivity tools (e.g., Excel, PowerPoint, Microsoft Office Suite).
• Excellent communication and interpersonal skills to foster collaboration with internal teams and external partners.
• Experience in quality improvement activities and familiarity with reimbursement methodologies preferred.

Work Traits:

• Strong communication skills to effectively present to groups and individuals.
• Critical thinking and problem-solving skills to assess health needs, identify risk factors, and develop appropriate interventions.
• Organizational and time management skills to manage multiple tasks and prioritize workload effectively.
• Flexibility and adaptability to adjust strategies based on the needs of individuals and groups.
• Collaboration and teamwork to work effectively with healthcare professionals, vendors, and community organizations.
• Professionalism and ethical conduct to adhere to legal standards and maintain confidentiality.
• Commitment to continued learning and adaptability to new software systems and technological advancements.

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We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits. 

Below are the minimum core benefits you’ll get, depending on your job level these benefits may improve:

• Medical/dental/vision plans, which start from day one!
• Life and accident insurance
• 401(K) and Roth options
• Tax-advantaged accounts (HSA, FSA)
• Educational expense reimbursement
• Paid parental leave

Other benefits include:

• Digital mental health services (Talkspace)
• Flexible work hours (availability varies by office and job function)
• Training programs
• Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing
• Charitable matching gift program
• And more...

We value inclusion and diversity

Click Here to review our U.S. Eligibility Requirements

Inclusion and diversity (I&D) is a core part of our business, and it’s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work.

Gallagher embraces our employees’ diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest.

Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as “protected characteristics”) by applicable federal, state, or local laws.

Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.

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