Job Description:
• Supervises and supports the implementation of clinical initiatives and/or programs to enhance care coordination, operational efficiency, and quality outcomes
• Oversees daily clinical operations and staff to ensure processes are executed consistently in alignment with NCQA standards, state regulations, and applicable contractual requirements
• Coordinates and supports clinical, quality, documentation, and data submission activities to support operational and quality objectives
• Reviews utilization, outcome, safety, and cost data and escalates identified trends or concerns to leadership for further action
• Monitors individual and team performance metrics, identifies performance gaps, and provides coaching or escalates concerns to leadership as appropriate to support operational and quality goals
Requirements:
• Bachelor's degree
• 4+ years of related experience
• RN - Registered Nurse - State Licensure and/or Compact State Licensure required
• Experience in clinical appeals or utilization management processes strongly preferred
Benefits:
• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• flexible approach to work with remote, hybrid, field or office work schedules