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Clinical Specialist, Technology Product Owner

Date:  Jan 5, 2022
Location: 

Any city, TX, US, 99999

Req ID:  7285

Summary

We are seeking a talented individual for a Clinical Specialist who provides clinical subject matter expertise to the Clinical Policy Team. Primary responsibilities include: develop clinical content standards, liaison with Clinical Services team, maintain expertise in Gainwell clinical review products and processes, SME support for account management and sales teams, internal and external education on clinical programs, identify and remediate performance gaps in Gainwell's clinical programs, develop new ideation and concept briefs for Gainwell's clinical programs.

Job Description

Essential Responsibilities:

  • Work in conjunction with the physician team to develop and document clinical content standards. Identify best practices in the company or industry and use in standard development. Clinical content standards will drive clinical decision making and documentation for the Clinical Services, Quality and Appeals teams.
  • Work with HR, Training and Education teams to make sure that clinical content standards are well understood by all levels of the organization. 
  • Liaison with leadership of applicable departments to assure that clinical content standards are the basis for decision making and documentation performed by the operational teams.
  • Maintain expertise in current Gainwell clinical program processes, work flows and outcomes
  • Provide primary SME support regarding Gainwell clinical policy, clinical review programs and processes to account management and sales teams for both State and Health plan clients. 
  • Meet with clients to explain programs and processes, discuss concerns, identify issues and develop proactive solutions to problems that clients may be having or anticipate having with Gainwell clinical review programs.
  • Participate in review and analysis of existing Gainwell clinical review programs; identify performance gaps and assist with developing plan to improve program performance
  • Generate ideas for new ideation, assist with developing review concepts, concept briefs and scoping analysis and documentation as assigned.
  • Support provider centric delivery on Gainwell programs and policies
  • Assist in developing clinical content for Gainwell clinical acquisition programs and provide assistance as needed in acquisition integration
  • Support industry awareness of Gainwell as clinical leaders, writing white papers, preparing and/or delivering conference presentations, etc.

Non-Essential Responsibilities:

  • Performs other functions as assigned 

Job Description

Knowledge, Skills, and Abilities:

  • Familiar with principals of clinical audit, utilization review and payment integrity programs.
  • Familiar with federal and state regulations and payment integrity industry standards
  • Experience with Gainwell clinical claims review program processes, work flows and outcomes
  • researching federal and state regulations as well as industry standards from a variety of sources
  • Excellent verbal and written communication skills. 
  • Ability to comfortably present Gainwell programs to client leaders and staff

Work Conditions and Physical Demands:

  • Primarily sedentary work in a general office environment
  • Ability to communicate and exchange information
  • Ability to comprehend and interpret documents and data
  • Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)
  • Requires manual dexterity to use computer, telephone and peripherals
  • May be required to work extended hours for special business needs
  • May be required to travel at least 10% of time based on business needs

Qualifications

Minimum Education:

  • Bachelor’s Degree or 10 years of experience in lieu education and experience 

Certifications:

  • Required Nursing license, Coding certificate, or other licensed clinical professional

Minimum Related Work Experience:

  • 7-9 years of experience with a combination of the following:
  • experience in the healthcare field as a nurse/clinician
  • experience in one of the following areas: 
  • Health insurance
  • Client service/business to business,
  • Healthcare policy

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