Clinical Operations Specialist at Judge Group
Independence, MO
About the Job
Location: Independence, MO
Salary: $26.00 USD Hourly - $30.00 USD Hourly
Description:
Contact: scosciakranias@judge.com
Salary: $26.00 USD Hourly - $30.00 USD Hourly
Description:
Judge Healthcare is seeking a Clinical Operations Specialiste for one of our top clients in the Independence, MO area.
Position Details:
Title: Clinical Operations Specialist
Location: Independence, MO 64056
Type of Engagement: Contract 6+ months
Specific Duties:
- Performs routine administrative workflow tasks that support functions of Clinical Operations. Identifies cases for internal and external Clinical programs.
- Uses various communication methods to identify and solicit information from providers and vendors as relevant to clinical and business need.
- Coordinates, reviews and investigates claims to determine the medical necessity and appropriateness of the care
- Determines simple cases that require review by Medical Director, Pharmacist or nurse.
- Interprets medical review results to determine compliance with contract provisions.
- Reports suspicions of compliance, clinical, quality, and regulation concerns
- Identifies cases for care and cost management
- Recommend benefit allowances in alignment with contract liabilities
- Actively engages in communication and response with internal and external customers regarding care management, products, and services
- Directs processing of contractual benefits after investigation is complete
- Escalates complex cases to senior team member.
Requirements/Qualifications:
- Requires two years (60 credit hours) of college or 2 years of healthcare experience.
- Experience using InterQual is required.
- Additional years of qualifying work experience may be considered in lieu of formal education.
- Requires intermediate proficiency with technology applications and systems.
- Requires experience using Microsoft office products, i.e., Outlook, Excel, Word, Teams.
- Requires effective written and verbal communication skills.
- Functions as part of the MMD Member Experience team, managing incoming calls and faxes from members and providers
- Preferred experience taking inbound calls and making outbound calls.
Work hours: M-F, 40 hours a week, CST time zone
Please send your updated resume and the job number to Sophia Kranias at SCosciaKranias@judge.com for immediate consideration.
Thank you for your time and I look forward to hearing from and working with you.
Regards,
Sophia Kranias
Healthcare Recruiter
The Judge Group
Phone: 610-784-8213
Contact: scosciakranias@judge.com
This job and many more are available through The Judge Group. Find us on the web at www.judge.com
