Clinical and Regulatory Program Consultant

🔥 24 minutes ago

🏄 California – Remote

🏄 California – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🚔 Compliance

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ZeOmega

WebsiteLinkedInAll Job Openings

501 - 1000 employees

⚕️ Healthcare Insurance

🤖 Artificial Intelligence

📋 Compliance

💰 Corporate Round on 2020-10

Healthcare Insurance • Artificial Intelligence • Compliance

ZeOmega is a leading healthcare technology organization known for its Jiva Healthcare Enterprise Management Platform, which provides solutions for care management, population health management, and quality improvement. The company's AI-powered platform integrates data to create a single source of truth for healthcare organizations, allowing for efficient benefits administration, operational efficiency, and improved care quality. ZeOmega serves a variety of healthcare entities including health care plans, health systems, Medicare, Medicaid, and Accountable Care Organizations, offering tools for risk adjustment, electronic prior authorization, and social determinants of health integration. The company is recognized for its excellence in payer care management solutions, earning the Best in KLAS award from 2022 to 2024.

📋 Description

• Works collaboratively with implementation and support teams to ensure client business and clinical requirements are accurately captured and addressed throughout the implementation process and beyond. • Serves as a subject matter expert on clinical best practices and health plan regulatory compliance, ensuring that ZeOmega’s solutions align with industry standards and meet client needs. • Focuses on enhancing the end-user experience by promoting usability and workflow efficiency.

🎯 Requirements

• Strong industry knowledge of California regulations and health plan experience. • Minimum of 3 years of clinical experience, preferably within a managed care or health plan setting. • Strong working knowledge of DHCS regulations, Medi-Cal program policy, and California state healthcare compliance requirements. • Familiarity with DHCS All Plan Letters (APLs), Medi-Cal Managed Care contracts, and related reporting requirements. • Demonstrated experience working with health plans, including utilization management, case management, or care coordination. • Familiarity with healthcare IT platforms and population health management solutions. • Ability to manage multiple projects and meet deadlines in a fast-paced environment. • Prior experience in consulting or implementation of healthcare technology solutions is a plus. • Expertise in clinical best practices and regulatory compliance for health plans. • Excellent communication and presentation skills. • Ability to analyze business requirements and translate them into solution design. • Current and unrestricted US LPN or RN license required.