Clinical Operations Specialist

Engaging with members and providers, the full-time Clinical Operations Specialist will perform routine administrative tasks to support Clinical Operations, educate stakeholders about benefits, and identify cases for clinical programs while working remotely. Key responsibilities Coordinate, review, and investigate claims to assess medical necessity and appropriateness of care Identify cases for care and cost management, escalating complex cases as needed Engage in communication with internal and external customers regarding care management and services Required qualifications Two years of college education (60 credit hours) or two years of healthcare experience Intermediate proficiency with technology applications and systems Experience using Microsoft Office products, including Outlook, Excel, Word, and Teams Ability to provide a non-cellular high-speed internet service for a home office Dedicated workspace to ensure confidentiality of member information Virtual Vocations Inc