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Clinical Leadership Expert

2 weeks ago


Denver, Colorado, United States Telligen Full time

At Telligen, we are dedicated to transforming lives and economies by improving health. As a key member of our team, the Clinical Leadership Expert will play a crucial role in guiding the clinical aspects of our population health management programs. This position requires substantial individual responsibility for the performance of medical necessity reviews, including appeals and peer-to-peer reviews of assigned contracts.

Key Responsibilities
  • Accountable for the accredited clinical service activities of the organization or assigned contracts.
  • Conducts critical peer reviews to ensure health services given are appropriate and necessary.
  • Serves as the medical expert with peer review and appeals processes.
  • Works closely with assigned teams to meet critical timelines.
  • Attends hearings either virtually or in person as required.
  • Instructs other physicians and clinical support staff on clinical policy, process, and improvement of health care services.
  • Supports Telligen in business development efforts.
  • Advises on policy and develops clinical personnel as required to improve lives and economies where our clients live and work.
  • Assists Telligen staff with training physicians and clinical support staff regarding their responsibilities and functions. Serves as a technical expert on the peer review and appeals processes.
  • Represents Telligen policies and procedures to medical and non-medical persons.
  • Participates in committee meetings representing the Company or as designated within assigned contracts.
  • Performs miscellaneous duties as assigned.