Senior Clinical Operations Specialist

Employer
GEHA, Inc.
Location
Lees Summit, Missouri
Salary
Negotiable
Posted
Apr 01, 2024
Closes
Apr 06, 2024
Ref
2741903985
Position Type
Specialist
Hours
Full Time
Practice Setting
Other
Work Mode
On-site
Employment Type
Permanent
Organization Type
Other
Summary

Performs complex administrative workflow tasks that support functions for the Clinical Operations team. Applies critical decision analysis and ability to independently create effective solutions to situations outside of a defined workflow. Engages and educates members about GEHA benefits and programs.

Duties
  • Assist with annual health plan accreditation requirements
  • Coordinate end-to-end testing and annual validation efforts for member wellness platforms
  • Support member inquiries regarding health rewards
  • Collect and analyze data related to wellness platforms, member and provider experience
  • May assist with medical record retrieval and complex case reviews
  • May apply nationally recognized guidelines to complex case reviews
  • May assist or lead department training for new and upskilling performance needs
  • Assists with delegated duties and tasks from the Clinical Operations team
  • Audits utilization of wellness benefits to aid in strategic decision making
  • Identifies and refers cases that would benefit from internal and external GEHA programs
  • Identifies trends and recommends changes/improvements to aid in meeting or succeeding department goals
  • Other duties as assigned