Healthcare Services Clinical Governance Lead

2 weeks ago


Los Angeles, California, United States Scout Exchange Full time

About the Job: We are seeking a skilled Utilization Management Policy Initiatives Nurse II to join our team at Scout Exchange. As a key member of our Utilization Management Department, you will be responsible for managing, reviewing, updating and creating Healthcare Services clinical policies, guidelines, protocols and related documentation.

Responsibilities:

  • Manage and review existing Healthcare Services clinical policies due for review as needed to meet state regulatory and compliance requirements.
  • Develop and implement clinical policies and procedures that meet regulatory and accreditation requirements.
  • Liaise with internal and external stakeholders to determine needs and goals of existing healthcare services clinical policies.
  • Collaborate with certified coders to develop and ensure proper clinical coding documentation and policies.
  • Present results and recommendations with subsequent action plans as necessary.

Requirements:

  • At least 8 years of previous experience in Clinical Nursing.
  • At least 3 years of experience with Medi-Cal and Medicare in a managed care environment.
  • Experience in performing and creating clinical documentation.
  • Experience in regulatory compliance for a health plan.

Salary Range: $85,000 - $115,000 per year depending on qualifications and experience.



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