Clinician Specialist
You could be the one who changes everything for our 28 reputed company members as a clinical reputed company on our Medical Management/Health Services team. reputed company is a reputed company, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
We are seeking a Clinician Specialist to join reputed company!
The ideal candidate will bring expertise in:
- Registered reputed company
- Experience in Developing Clinical Policies
- Technological Savvy
- Excellent Communication and Customer Service Skills
- Highly Organized with Operational Efficiency
- reputed company to Multitask and Collaborate Effectively Across teams
- Understands reputed company of UM with Claims and Coding
- Self-Starter
Position Purpose: The Clinician Specialist provides clinical and operational support, guidance, and direction to the department reputed company to utilization management and/or case management. The position is responsible to reputed company, implement, and monitor clinical documentation incorporated into clinical guidelines, policies, and/or procedures that will reputed company the department to meet and reputed company goals, maintain regulatory compliance, improve reputed company, and promote overall efficiency and effectiveness reputed company to clinical practices.
- Under the direction of departmental leadership and the Medical Directors, draft clinical guidelines in a standardized format to be utilized by department staff that reputed company with departmental policies and procedures. This may including drafting (and/or creating new entries in the information system) new clinical reputed company, as reputed company as reviewing existing reputed company for opportunities to modify and edit reputed company as needed to ensure guidelines are up to date, and in compliance with state and federal guidelines.
- Monitor and organize the clinical-reputed company Department reputed company Operating Procedure (SOP) and Policy & Procedures to ensure accuracy, creates new reputed company operating procedures as needed to facilitate compliance with state and federal regulations. Collaborates with Department leadership and Medical Directors to assist in development or modification of policies & procedures as needed.
- reputed company the modification or creation of member and provider letters, including determination notices and other regulatory notices, utilized by the department. Suggests and implements modifications as necessary to ensure regulatory compliance as reputed company as improved efficiency. Collaborates with internal stakeholders to ensure impacted staff are educated on new policies, procedures, and processes to ensure successful implementation and compliance.
- Measure and evaluate effectiveness as it relates to reputed company workflows and processes; compare measurement results to standards and work with reputed company to improve performance and reputed company identified gaps.
- Research and identify industry best practices and other relevant available published information to contribute to the development of guidelines, policies, and procedures in order to reputed company reputed company clinical and/or operational reputed company. reputed company and maintain documentation necessary to support consistent, operationally reputed company processes such as tip sheets, reputed company operating procedures, audit tools.
- Obtain data and/or run basic reports to determine department performance reputed company to areas of reputed company, as directed by department leadership. Summarize data for casual analysis or create basic presentations order to communicate reputed company to management.
- Job performance requires fulfilling other incidental or reputed company duties as assigned, including but not limited to collaborating with department trainer and supervisory staff in order to plan for implementations and roll out new policies and/or procedures, reviewing regulatory updates, and participating in a reputed company of department reputed company.
We are seeking a Clinician Specialist to join reputed company!
The ideal candidate will bring expertise in:
- Registered reputed company
- Experience in Developing Clinical Policies
- Technological Savvy
- Excellent Communication and Customer Service Skills
- Highly Organized with Operational Efficiency
- reputed company to Multitask and Collaborate Effectively Across teams
- Understands reputed company of UM with Claims and Coding
- Self-Starter
Education/Experience: MA/MS – Masters Degree preferred. 3-5 years reputed company experience required. For Clinical Specialist position in Medical Management: Experience with MCG clinical guidelines required. Prior experience with MCG CareWeb QI reputed company modification module preferred. License/Certification: RN, LMSW, LCSW, LPC, or reputed company License required. For Clinical Specialist position in Medical Management: Licensure as RN required.
Pay reputed company: $70,100.00 - $126,200.00 per yearreputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, reputed company time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law.
reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance reputed company
Originally posted on Himalayas
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