Serve as a liaison for external groups and providers regarding clinical information from the Operations and Medical Management teams. Assesses and performs review of member clinical records and services related to behavioral health and substance use. This is a remote position. Candidate must reside in and be licensed in the state of Missouri. Outpatient experience strongly preferred. Interpret and present program results and develop data-driven analysis and metrics used to measure effectiveness and ROI of all current and new programs Partner with various staff, along with internal and external departments on provider education and outreach; determine where there are gaps and work to develop and deploy education efforts Partner with regional leadership for providers requiring a clinical interpretation of results related to health plan reporting, data and quality incentive payments; facilitate discussions to make recommendations Implement and manage procedures for tracking, identifying and problem-solving operational issues, including issues between the provider network, community, and the facility, and make recommendations to solve Act as the clinical representative in various meetings Collaborate with staff to identify internal and external opportunities and initiate process changes to increase quality and improve staff, provider and member satisfaction Serve as resource and liaison on utilization, quality improvement and case management activities Performs other duties as assigned. Complies with all policies and standards.
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Job Type
Full-time
Career Level
Mid Level