DE032705-Health Clinical Svcs Specialist

Position Title

Health Clinical Services Specialist

Eligibility

Only applicants who already have the right to live and work in this country are eligible to apply for this role.

Work Setup

Return to Office

Responsibilities

• Oversee staff performing pre-service, concurrent, retrospective, out of network, and appropriateness of treatment setting reviews to ensure compliance with medical policy, member eligibility, benefits, and contracts.
• Maintain contractual, regulatory and accreditation compliance; identify and report suspected or confirmed issues to the Manager and/or Compliance Department on the same day.
• Ensure associates understand contractual, regulatory and accreditation requirements; report concerns immediately.
• Ensure all clinical USRN associates have active, documented licensure and remove associates from production when licensure is not verified; report expired or lapsed lic...