Clinician Specialist

This is a fully remote position, open to applicants in Oklahoma.

📋 Description

• Provide clinical and operational support, guidance, and direction regarding utilization management and/or case management.

• Develop, implement, and oversee clinical documentation integrated into clinical guidelines, policies, and procedures.

• Draft standardized clinical guidelines that align with departmental policies and procedures.

• Create new clinical criteria and review existing criteria to ensure compliance with state and federal regulations.

• Monitor and organize clinical-focused departmental SOPs along with policies and procedures.

• Generate new SOPs as necessary to ensure regulatory compliance.

• Collaborate with department leadership and Medical Directors on the development or modification of policies and procedures.

• Supervise the modification or creation of member and provider letters, determination notices, and other regulatory communications.

• Coordinate with internal stakeholders to educate affected staff on new policies, procedures, and processes.

• Measure and assess workflow and process effectiveness, identify gaps, and enhance performance.

• Research industry best practices and published materials to support the creation of guidelines, policies, and procedures.

• Develop and maintain tip sheets, SOPs, audit tools, and other operational documents.

• Gather data and generate basic reports to evaluate departmental performance.

• Summarize data and create basic presentations to convey progress to management.

• Collaborate with trainers and supervisory staff on the implementation and rollout of new policies and procedures.

• Review regulatory updates and engage in departmental projects.

⛳️ Requirements

• Strong project management and organizational abilities, with the capacity to handle multiple priorities and meet regulatory deadlines.

• Comprehensive understanding of Utilization Management processes, prior authorization tools, and regulatory compliance standards.

• Excellent communication and stakeholder engagement skills.

• Proficiency in data analysis, reporting tools, and software utilized for tracking and communicating regulatory and operational information.

• Capability to work independently with minimal supervision while navigating ambiguity and shifting priorities.

• An active RN license is required.

• Candidates must reside in Oklahoma.

• 3-5 years of relevant experience is required.

• MA/MS – A Master's Degree is preferred.

• Experience with MCG clinical guidelines is necessary for the Clinical Specialist position in Medical Management.

• Previous experience with the MCG CareWeb QI guideline modification module is preferred.

• RN, LMSW, LCSW, LPC, or MHC License is required.

• RN licensure is mandatory for the Clinical Specialist position in Medical Management.

• Standard schedule is Monday through Friday, from 8:00 a.m. to 5:00 p.m.

🏝️ Benefits

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.

• Additional incentive forms may be included in the total compensation package.

• Diversity-focused equal opportunity employer.