Licensed Clinical Specialist

A company is looking for a Claims Clinical Specialist - In-House Certification Specialist. Key Responsibilities Conduct telephonic assessments and communicate with medical personnel to develop care plans and provide certifications Obtain and analyze medical records to understand disease progression and care needs Identify process improvement opportunities and collaborate with teams to enhance performance and support continuous improvement initiatives Required Qualifications Active Licensed Social Worker or Registered Nurse At least two years of experience in a relevant role with knowledge of medical conditions affecting the aging process Ability to understand and interpret medical documentation and insurance contracts Demonstrated experience in risk management and making sound business decisions Good working knowledge of systems applications (e.g., WORD, EXCEL, PowerPoint)

Mar 25, 2025 - 16:40

A company is looking for a Claims Clinical Specialist - In-House Certification Specialist. Key Responsibilities Conduct telephonic assessments and communicate with medical personnel to develop care plans and provide certifications Obtain and analyze medical records to understand disease progression and care needs Identify process improvement opportunities and collaborate with teams to enhance performance and support continuous improvement initiatives Required Qualifications Active Licensed Social Worker or Registered Nurse At least two years of experience in a relevant role with knowledge of medical conditions affecting the aging process Ability to understand and interpret medical documentation and insurance contracts Demonstrated experience in risk management and making sound business decisions Good working knowledge of systems applications (e.g., WORD, EXCEL, PowerPoint)