CQE Manager I-Acupuncture (Medical)

TL;DR

CQE Manager I-Acupuncture (Medical): Rendering medical necessity review determinations for acupuncture services with an accent on clinical quality evaluation and evidence-based principles. Focus on verifying appropriate care for health plan members, conducting clinical investigations, and developing clinical policies.

Location: Remote (Must hold a current, unrestricted license to practice in California)

Salary: $69,200 – $85,000

Company

hirify.global provides clinical quality evaluation and medical necessity review services for health plan members.

What you will do

• Manage and perform medical necessity reviews of acupuncture services from network and non-network practitioners.
• Verify and approve clinically necessary care using evidence-based principles and professional experience.
• Support clinical credentialing and medical records review for Network Practitioners.
• Conduct clinical investigations for quality-of-care issues and present findings to committees.
• Collaborate with senior management to develop clinical programs, policies, and protocols.
• Participate in regulatory, accreditation, and health plan audits.

Requirements

• Professional degree in Acupuncture from an accredited college or university.
• Current, unrestricted license to practice in California.
• Minimum of 5 years of clinical experience.
• Proficiency in computer systems including Outlook, MS Word, SharePoint, and Microsoft Teams.
• Ability to work from home with a stable internet connection (minimum 50 Mbps download / 10 Mbps upload).

Nice to have

• Additional post-graduate degree in acupuncture or a related field.
• Specific experience with medical necessity case review.
• Fluency in Chinese or Korean languages.
• Advanced certification in quality management, case management, or data analysis.

Culture & Benefits

• Full remote/work-from-home environment.
• Company-provided technology equipment for the designated work area.
• Commitment to equal opportunity and affirmative action employment.