Clinician Specialist

Location: Remote-IN; remote position in the United States

Salary: $70,100–$126,200 per year

Company

hirify.global provides healthcare services focused on connecting people with the care they need and improving healthcare accessibility and outcomes.

What you will do

• Draft, create, review, and update clinical guidelines and criteria for utilization management and case management.
• Maintain department standard operating procedures and policies to support state and federal regulatory compliance.
• Oversee member and provider letters, determination notices, and other regulatory communications.
• Measure workflow and process effectiveness, identify performance gaps, and support operational improvements.
• Research industry best practices and create documentation such as tip sheets, audit tools, and standard operating procedures.
• Prepare basic performance reports and presentations and collaborate with leadership, Medical Directors, trainers, and supervisory staff on implementations.

Requirements

• Active RN, LMSW, LCSW, LPC, or MHC license required; RN licensure is required for Medical Management positions.
• 3–5 years of related experience.
• Experience developing clinical policies in a managed care environment.
• Experience with MCG clinical guidelines required for Medical Management positions.
• Strong communication, customer service, organization, multitasking, collaboration, and operational efficiency skills.
• Master’s degree preferred; familiarity with MCG CareWeb QI guideline modification is preferred for Medical Management positions.

Culture & Benefits

• Remote work arrangement with a flexible approach to remote, hybrid, field, or office schedules.
• Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, and holidays.
• Work focused on improving healthcare access and supporting individuals, families, and communities.
• Equal opportunity workplace committed to diversity and inclusion.