Clinician Specialist

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

📋 Description

• Provides clinical and operational assistance, guidance, and direction to the department concerning utilization management and/or case management.

• Develops, implements, and monitors clinical documentation that is integrated into clinical guidelines, policies, and/or procedures.

• Creates clinical guidelines in a standardized format for use by department staff that aligns with departmental policies and procedures.

• Oversees the review and organization of the clinical-focused Department Standard Operating Procedure (SOP) and Policy & Procedures to ensure correctness.

• Manages the modification or creation of correspondence for members and providers, including determination notices.

• Works collaboratively with Department leadership and Medical Directors to assist in the development or modification of policies & procedures as necessary.

• Researches and identifies industry best practices and other relevant published information to inform guideline development.

⛳️ Requirements

• Must reside in IN

• Registered Nurse

• Experience in developing clinical policies

• Technologically savvy

• Excellent communication and customer service skills

• Highly organized with a focus on operational efficiency

• Ability to multitask and collaborate effectively across teams

• Understanding of the interface between UM and claims and coding

• Self-starter

• MA/MS – Master's Degree preferred

• 3-5 years of related experience required

• Experience with MCG clinical guidelines required

• Prior experience with the MCG CareWeb QI guideline modification module preferred

• License/Certification: RN, LMSW, LCSW, LPC, or MHC License required. For Clinical Specialist position in Medical Management: Licensure as RN required.

🏝️ Benefits

• Competitive pay

• Health insurance

• 401K and stock purchase plans

• Tuition reimbursement

• Paid time off plus holidays

• Flexible work arrangements with options for remote, hybrid, field, or office work schedules