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Job Type
Full-time
Description
The Clinical and Regulatory Program Consultant 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. This role 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. The Clinical and Regulatory Program Consultant also focuses on enhancing the end-user experience by promoting usability and workflow efficiency.
*Must be currently located in CA*
Our company is committed to equal employment opportunity. We will not discriminate against employees or applicants for employment on any legally recognized basis [“protected class”] including, but not limited to: veteran status, uniform service member status, race, color, religion, sex, sexual orientation, national origin, age, physical or mental disability, genetic information or any other protected class under federal, state, or local law.
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.