Clinical Operations Specialist
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Job Summary
Engaging with members and providers, the full-time Clinical Operations Specialist will perform administrative tasks to support Clinical Operations, including educating stakeholders about benefits and identifying cases for clinical programs, while working remotely from the Kansas City Metropolitan area.
Key responsibilities:
- Coordinates and investigates claims to assess medical necessity and appropriateness of care
- Identifies cases requiring review by Medical Director, Pharmacist, or nurse, and escalates complex cases as needed
- Communicates with internal and external customers regarding care management, products, and services
Required qualifications:
- Two years of college (60 credit hours) or two years of healthcare experience
- Intermediate proficiency with technology applications and systems
- Experience using Microsoft Office products, including Outlook, Excel, Word, and Teams
- Must reside in the Kansas City Metropolitan area
- Ability to provide a non-cellular high-speed internet service for a home office
Complete Job Description
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