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Specialist, Clinical Operations

3 months ago

Woodland Hills, United States MedPOINT Management Full time

**Summary**:
Under the direction of the Supervisor, Clinical Operations (COPS), the Specialist, COPS primary responsibility is to support a strategic approach to the development of actionable recommendations that improve the quality, access, and sustainability of MedPOINT’s clients’ network.

**Duties and Responsibilities**:

- Member of MPM’s COPS committee, with the goal of identifying claims & UM initiatives to drive cost efficiency and quality improvement for MPM Clients
- Identify key utilization areas for analytical focus, especially those with potential opportunity and risk
- Utilize analytical tools to examine provider behavior & practices to optimize operational efficiency
- Support the development and communication of strategic recommendations based on analyses to MPM Executives during COPS committees
- Lead efforts, both internally and externally, to operationalize strategic recommendations pertaining to MPM activities and also inform and drive change with external vendors, providers, and stakeholders
- Advance COPS initiatives with other departments, including Utilization Management, Claims, Compliance, and Finance
- Develop and lead efforts around workflows between UM and Claims departments
- Research and build the knowledge base for COPS and SOPI initiatives by attending conferences and pursuing self-study in areas regarding billing practices, provider behavior and operational improvements that could benefit COPS Committee and MPM operations
- Mitigate financial impact and utilization via ad hoc clinical review with other departments and lead & advise other departments in their continuous improvement efforts when pertaining to clinical review
- Build and maintain relationships with UM and Claims Leadership to be a key advisor to their departments on behalf of SOPI
- Provide clinical review and identify potential fraud, waste, and abuse practices

**Minimum Job Requirements**:

- Clinical background with intimate knowledge of injectables, coding practices, and normal billing procedures
- Familiarity with current managed care regulatory processes
- Intermediate proficiency with Microsoft Office Excel
- Familiarity with EncoderPro and Virtual Examiner

**Skills and Abilities**:

- Capable of completing complex longitudinal analyses
- Positive attitude and flexibility, a must
- Ability to deliver on departmental and company goals
- Ability to work effectively with all levels of the organization and stakeholders
- Ability to learn about regulatory requirements and provider contracting

**Salary Range**:

- $75k-85k annually