The Clinical Specialist is the subject matter expert responsible for all clinical case development and resolution within the Appeals & Grievances unit, managing member complaints, grievances, and appeals pertaining to service authorization or delivery. This involves independently researching issues, interpreting regulations, resolving cases, and preparing detailed documentation for Medical Director Review and external appeal processes.

The Clinical Care Reviewer II is responsible for processing medical necessity reviews for behavioral health services and assisting with care coordination and discharge planning. This role involves engaging with care partners and maintaining compliance with regulations.

The role involves providing clinical triage and telephonic case management at the initial report of Workers' Compensation claims to ensure timely medical care and support early return-to-work outcomes. Key duties include performing clinical assessments, developing initial care plans, facilitating communication between all stakeholders, and monitoring treatment adherence.

The role involves providing specialized diagnostic and interventional radiology services, focusing on mammography, with opportunities for remote teleradiology moonlighting on days off. Candidates will join a collaborative team in Washington State and Alaska.