Clinical Rules Management Director

Job Summary

A company is looking for an Associate Director, Clinical Rules Management.

Key Responsibilities

• Collaborate with clinical staff to develop and implement systems that improve patient outcomes
• Conduct regular system audits to ensure data accuracy and quality
• Lead the evaluation of clinical processes and facilitate process redesign in collaboration with clinical teams

Required Qualifications, Training, and Education

• Bachelor's degree with 7-10 years of relevant work experience
• Experience in managing small to mid-sized teams
• Good understanding of specialty benefit management business
• Knowledge of ICD-10-CM and CPT coding assignments
• Project management skills to handle multiple time-sensitive tasks