Associate Director, Clinical Services

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.

Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.  

Job Description:

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work.  Our team members and leaders are expected to foster connection and teamwork by being present in the office at least 2 days per week.

The opportunity

The Associate Director, Clinical Services leads a staff of Registered Professional Nurses (RN’s) and Clinical Underwriting Team to ensure accurate and timely clinical reviews in conjunction with an eye to assure optimization of health, risk mitigation, and support of our internal and external clients in understanding of disease processes and the potential treatment needs of the same.  

How you will contribute:

Manage professional staff to:

·         Provide accurate and timely consultation on referrals from the Underwriting team and other internal clients

·         Identify members who could benefit from additional resources like Clinical 360 cost containment measures

·         Optimize both risk and health outcomes

Drive team performance and growth:

·         Conduct regular Quality Assurance (QA) reviews and provide coaching

·         Set performance goals and conduct reviews using appropriate tools

·         Offer career development and training opportunities

·         Make key personnel decisions (hiring, terminations, promotions, salary increases)

Foster innovation and collaboration:

·         Support staff in identifying and implementing innovative solutions

·         Build collaborative relationships within the Underwriting organization

·         Facilitate partnerships across the broader Health and Risk solutions claims organization

Lead strategic initiatives:

·         Contribute to special projects and change management activities

·         Promote the company's philosophy, strategies, and business objectives

·         Develop an interdisciplinary clinical model aligned with business needs

Maintain operational excellence:

·         Manage operating expenses within budget

What you will bring with you:

·         Ability to work with a diverse range of people.

·         Experience Registered Nurse (RN) with 3-5 years’ experience in Stop Loss or similar financial/insurance field.

·         Experience in Clinical UW for Stop Loss or similar financial or health products. 

·         Registered Nurse in Good standing, additional certifications a plus

·         High level of medical expertise and business knowledge of claims risk management

·         Demonstrated ability to coach and develop others

·         Able to solve problems that don’t have clear solutions or outcomes

·         Strong analytical and critical thinking skills

·         Strong project management and organizational skills

·         Collaborative and comfortable in cross functional organizations

·         Excellent communication skills

Salary $101,000 - $151,500

At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we stri