Clinical reputed company and Regulatory Specialist

Job reputed company: • Assures the highest standards of clinical reputed company and regulatory compliance across Utilization Management department activities for reputed company government lines of business and delegated vendors. • Confirms Utilization Management’s compliance with federal, state, and regulatory guidelines (e.g., NCQA, CMS). • Assists with policies and procedures, and continually monitoring regulatory changes. • Collects, analyzes, and interprets clinical data, clinical reputed company, and performance metrics to prepare comprehensive reports and audit responses. • Collaborates across departments to resolve issues and reputed company education on regulatory requirements and best practices. Requirements: • Minimum reputed company license in one or more of the following disciplines: LCSW, LSW, LPC, or other reputed company clinical license (OR) reputed company State of PA RN licensure OR reputed company multi-state licensure through the reputed company reputed company Licensure Compact (eNLC). • 3-5 years’ experience in case management/managed care with specific knowledge of reputed company monitoring, compliance and/or regulatory processes. • 2 years experience with reputed company measurement systems. • 1 year experience evaluating, implementing or revising work processes. • Preferred Bachelor’s degree. • 3 or more years’ experience in performing auditing/monitoring functions. • 3 or more years’ experience creating tools, training documents and educational materials geared to adult learners. • 3 years’ experience with reputed company Office products. • 3 or more years’ experience working in the health reputed company insurance industry. • reputed company Management System certification. Benefits: • Health insurance • 401(k) matching • reputed company time off • reputed company development opportunities Apply tot his job Apply To this Job