Clinical Services Compliance Specialist
Qualifications:
· Bachelor’s degree (BSN) preferred
· Active PA registered nurse license
· 3-5 years’ experience in a clinical role in a managed care environment; preferably within a health plan.
· Experience with case management and/or precertification is essential.
· Experience supporting quality management and/or compliance is strongly desired.
Required Skills:
· Must have strong interpersonal skills with demonstrated ability to provide associate feedback and support while maintaining positive, productive interpersonal relationships.
· Knowledge of utilization review processes and utilization management systems, moderate to strong knowledge of InterQual required
· Excellent verbal and written communication skills with a key focus on attention to detail.
· Strong use of Excel, Power Point and word and Visio.
· Knowledge of IBC/AmeriHealth systems, 3 or more years of experience within the clinical services division preferred.
· Experience adhering to NCQA and other programs requiring regulatory compliance.
· Strong problem-solving abilities, organizational and planning skills.
Inclusion and Belonging
At IBX, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
About Our Company
Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!
Equal Employment Opportunity
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.