Data Governance Manager responsible for establishing data governance framework. Leading data quality initiatives and ensuring regulatory compliance at AP+ payments organization.
About the role
- Senior Clinical Consultant using extensive medical expertise for reviewing claims and assessing treatment costs in a hybrid work environment. Collaborating with internal and external teams on various healthcare solutions.
Responsibilities
- Use technical expertise and clinical experience to coordinate with senior management, claims specialists, underwriting, sales team, and TPAs to review medical claims for appropriateness, identify cost savings opportunities, and assess potential risk.
- Investigate and negotiate medical and prescription charges, suggest care alternatives, and identify billing errors for potential cost savings opportunities.
- Review complex medical treatment plans for appropriateness and coverage, including treatments such as transplants, CAR-T therapies, and up-and-coming gene therapies.
- Create and facilitate educational presentations for a variety of internal and external audiences.
Requirements
- Active Registered Nurse license
- 5+ years of clinical nursing experience is required
- Prior Stop Loss insurance experience or 3+ years of Medical in-depth case management experience preferred
- Excellent working knowledge of current medical conditions and treatment plans, including but not limited to an understanding of organ and tissue transplantation, oncology, cardiac or other critical illness
Benefits
- generous vacation and sick time
- market-leading paid family, parental and adoption leave
- medical coverage
- company paid life and AD&D insurance
- disability programs
- partially paid sabbatical program
- 401(k) employer match
- stock purchase options
- employer-funded retirement account
- flexible, inclusive and collaborative work environment that supports career growth
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