Clinical Business Lead

CenterWell • Work at Home - Kentucky, KY

2d • $104,000 - $143,000 • Remote

About The Position

The Lead Clinical Implementation Consultant serves as the clinical subject matter expert responsible for translating utilization management requirements into consistent operational workflows and technology solutions. This role provides clinical leadership for enterprise initiatives by interpreting clinical requirements and ensuring they are accurately implemented across clinical decision support tools, electronic prior authorization, claims operations, and supporting technology platforms. Working collaboratively with Medical Directors, Referrals and Authorizations, Claims, Product, and Technology, this position ensures new clinical services, procedure codes, and utilization management requirements are implemented consistently throughout the organization while improving provider experience, operational efficiency, and clinical accuracy. The Clinical Business Lead oversees the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Requirements

• Bachelor's degree
• 2 or more years of project leadership experience
• 8 or more years of technical experience
• Applicable State licensure in field of study
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• US Citizenship required for this Position

Responsibilities

• Serves as the clinical subject matter expert responsible for translating utilization management requirements into consistent operational workflows and technology solutions.
• Provides clinical leadership for enterprise initiatives by interpreting clinical requirements and ensuring they are accurately implemented across clinical decision support tools, electronic prior authorization, claims operations, and supporting technology platforms.
• Ensures new clinical services, procedure codes, and utilization management requirements are implemented consistently throughout the organization while improving provider experience, operational efficiency, and clinical accuracy.
• Oversees the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members.
• Advises executives to develop functional strategies (often segment specific) on matters of significance.
• Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision.
• Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Benefits

• medical, dental and vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Senior