Clinical Operations Specialist at The Judge Group Inc. in Independence, Missouri

Job Description:

Location: Independence, MO

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

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Contact: scosciakranias@judge.com


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