Clinical Operations Specialist
11 hours ago
At Mindlance, we're seeking a skilled Clinical Operations Specialist to join our team. As a key member of our Utilization Management (UM) team, you will be responsible for ensuring compliance with UM and Quality Review (QR) standards across our network of healthcare providers.
About the Role:
This is a dynamic position that requires strong analytical, communication, and problem-solving skills. You will work closely with medical groups, IPAs, and HMOs to evaluate UM/QR plans, identify areas for improvement, and implement corrective action plans.
Key Responsibilities:
- Evaluate UM/QR plans for prospective and existing medical groups/IPAs in the HMO networks.
- Prepare reports on findings and communicate outcomes to medical groups/IPAs and HMO management.
- Communicate contractual requirements to medical groups, IPAs, and contract management firms.
- Monitor UM activities of medical groups/IPAs to measure adherence to HMO UM/QR standards.
- Oversee the development and implementation of corrective action plans for deficient medical groups/IPAs.
- Design and implement in-services, seminars, and special presentations to promote the UM/QR process.
Requirements:
- Registered Nurse (RN) with unrestricted license.
- 3 years clinical experience with 2 years' experience in utilization review, quality assurance, or statistical research.
- Clinical knowledge, knowledge of the UM/QR process, and knowledge of managed care principles.
- Analytical, verbal and written communications skills.
- Current Illinois driver's license. Able and willing to travel, including overnight stays.
Salary: $80,000 - $110,000 per year, depending on experience.
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