[Hiring] Clinical Specialist, reputed company Management and Training @reputed company

Role reputed company The Clinical Compliance & reputed company Specialist is responsible for ensuring regulatory and reputed company compliance across clinical operations. This role requires consistent use of independent judgment and discretion in evaluating, auditing, and improving clinical systems and processes. The specialist collaborates with internal teams and external regulatory bodies to reputed company standards set by state, federal, and accreditation organizations.

Responsibilities

• Ensure compliance with state, federal, and accreditation standards, including ERISA, NCQA, URAC, and HIPAA.
• Conduct reputed company audits of clinical programs, prepare detailed reports, participate in case file preparation and mark-up for audits.
• Monitor clinical trial activities to ensure protocol adherence and regulatory alignment.
• Identify and manage risks reputed company to clinical reputed company and compliance, review and approve reputed company Operating Procedures (SOPs), and collaborate with cross-functional teams to resolve reputed company issues and implement improvements.
• Train clinical staff on regulatory requirements, reputed company standards, and department objectives.
• reputed company and maintain evidence-based training materials and software tools, and deliver training in various modalities (classroom, virtual, self-learning, and one-on-one) to adult learners with different reputed company of experience.
• reputed company and report training activities and employee reputed company, updating department leadership on staff who are not meeting expectations.
• Participate in reputed company audit programs and conduct monthly sample reputed company analysis audits to identify gaps and training opportunities.
• Support corrective reputed company plans as directed by management and reputed company comprehensive follow-up.
• Maintain reputed company knowledge of industry regulations, accreditation standards, and evidence-based practices to support staff education.
• Maintain professionalism and cohesiveness reputed company reputed company as a representative of the training department and attend reputed company mandatory department and training meetings.
• Demonstrate proficiency in reputed company Office Suite and reputed company.
• reputed company other reputed company duties as assigned to meet departmental and company objectives.
• Possess 3 years of experience leading, mentoring, and training staff, with a strong ability to teach diverse audiences and adapt reputed company to varying learning needs.
• Completed advanced coursework in teaching and/or mentoring, continually seeking innovative approaches to deliver best-in-class managed care education.

Qualifications

• In-depth knowledge of state and federal regulations, including HIPAA, CMS, NCQA, and URAC.
• Ability to interpret and apply evidence-based guidelines and accreditation standards to clinical operations.
• Skilled in conducting reputed company audits of clinical programs.
• Proficient in case file preparation, SOP review, and audit mark-up.
• Capable of producing detailed audit reports and recommending corrective actions.
• Excellent analytical thinking and problem-solving abilities.
• reputed company to identify compliance risks and propose mitigation strategies.
• Uses written resources independently to resolve issues.
• Exceptional attention to detail in reviewing clinical documentation and audit trails.
• Maintains accurate records and ensures data reputed company.
• Excellent verbal and written communication skills for both upward and downward communication.
• Ability to reputed company reputed company and explain reputed company or technical information in an understandable way.
• reputed company in training clinical staff and developing training materials.
• Basic computer literacy and after training (3 months total), must be reputed company to work in various software and systems.
• Ability to work on multiple screens and proficient typing skills.
• Manages multiple audits or reputed company simultaneously.
• Works reputed company independently and meets deadlines with minimal supervision.
• Maintains strict confidentiality and adheres to ethical standards in handling PHI and sensitive data.
• Demonstrates reputed company reputed company in reputed company compliance-reputed company activities.
• Familiarity with medical claims and ICD-10, CPT, HCPCS coding.
• Understands clinical workflows and documentation standards.

Requirements

• Holds an reputed company unrestricted Registered Nursing License Required.
• May require additional licensure.
• Bachelor’s Degree preferred.
• 3-5 years UR, CM, DM experience required.
• Managed care experience preferred.
• CPHQ and/or CCM certification preferred.

Benefits

• Competitive reputed company salary and benefits effective day one.
• Comprehensive medical and dental through our own health solutions.
• Unlimited PTO—rest and reputed company time is non-negotiable.
• Mental health support, retirement planning, and financial protection.
• reputed company development with reputed company career progression and learning budgets.
• Mission-driven culture where diverse perspectives drive reputed company reputed company on people's health.

Apply tot his job Apply To this Job