Develop and revise Clinical Operations policies and present these policies to UM Committee and the Policy and Compliance Committee for approval.
Monitor new and updated regulations, APLs, and CMS rules and perform gap analyses to identify compliance risks.
Develop and deliver training on new or updated UM policies to internal staff.
Prepare pre-onsite documentation for external audits (DHCS, DMHC, CMS, NCQA).
Provide administrative support for UM Committee (agendas, minutes, compliance tracking) and ensure UM Committee actions are implemented and documented.
Draft member and provider-facing UM communications (e.g., website and newsletter content).
Develop work plans for achieving goals and implementing projects helping the Clinical Operations team.
Help develop reports and conducting analysis to manage Clinical Operations process improvements and quality efforts.
Work with UM Program Manager and Clinical Operations leadership to facilitate Clinical Operations regulatory and accreditation audit processes.
Create Clinical Operations documents such as DeskTop Processes and reference materials.
Annual Salara between 60-90k depending on experience