Clinical Solutions SME (RN License)
Job Summary
To support federal health initiatives, the fully remote Clinical Solutions Subject Matter Expert (RN License) will provide clinical expertise in Medicare and Medicaid medical review, develop operational workflows, and collaborate with business development teams to enhance solution offerings.
Key responsibilities
- Provide clinical subject matter expertise for federal health pursuits, focusing on medical review and quality improvement
- Develop end-to-end operational workflows and document functional requirements from various sources
- Collaborate with solution architects and technical staff to ensure alignment between clinical processes and technology capabilities
Required qualifications
- Active or previously held clinical license (RN, LPN, or comparable) or equivalent clinical operations experience
- Minimum of 8 years of experience in healthcare operations, medical review, or program integrity
- Working knowledge of Medicare fee-for-service coverage and payment rules
- Experience translating clinical and regulatory requirements into documented processes
- Bachelor's degree in healthcare, business, or a related field, or equivalent combination of education and experience
Complete Job Description
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