Demo

Clinical Services Specialist

Comp-X Medical Management
Jacksonville, FL Full Time
POSTED ON 4/21/2025
AVAILABLE BEFORE 5/15/2025

Job Description

Job Description

Position Summary : The Clinical Services Specialist focuses on supporting the clinical aspects of physical medicine, home health, DME, and diagnostic services for injured workers. This role ensures the delivery of high-quality, appropriate, and necessary medical care, while coordinating care based on industry guidelines, WC state requirements, and fee schedules, in the most efficient, cost-effective manner possible.

Key Responsibilities :

Clinical Support :

Assist in the implementation and monitoring of clinical initiatives that align with organizational goals.

  • Provide clinical support for the physical medicine, home health, DME, and diagnostic services teams, ensuring appropriate and cost-effective measures are followed during the fulfillment process.
  • Help in the development and updating of clinical protocols and guidelines to reflect best practices.

Home Health Department :

Assess and monitor home health cases, ensuring that injured workers are progressing towards their desired outcomes.

  • Collaborate with injured workers, family members, discharge planners, adjusters, nurse case managers, and providers to ensure that home health services meet the unique needs of injured workers.
  • Operational Support :

    Contribute to the efficient and cost-effective delivery of clinical services by monitoring workflows and ensuring proper documentation practices are followed.

    Stakeholder Collaboration :

    Serve as a key clinical liaison between the company, healthcare providers, nurse case managers, and customers, with a patient-centric approach.

  • Build and maintain relationships with external partners, including medical providers, insurance carriers, TPAs, employers, and nurse case managers.
  • Compliance and Quality Assurance :

    Ensure adherence to WC state requirements, laws, fee schedules, regulations, and accreditation standards.

  • Assist in monitoring clinical activities to ensure compliance with quality assurance metrics and resolve any clinical concerns or complaints promptly.
  • Data Analysis and Reporting :

    Analyze clinical data to evaluate program outcomes and identify trends.

  • Support the preparation and presentation of reports on clinical performance metrics for internal use.
  • Qualifications :

  • Bachelor’s degree in Nursing (BSN).
  • Current, active, and unrestricted RN license.
  • Minimum of 5 years of experience in workers’ compensation and case management.
  • Case Management Certification (CCM) preferred.
  • Strong knowledge of the workers' compensation industry, including state requirements, treatment guidelines, and medical fee schedules.
  • Proficiency in healthcare software and data management systems.
  • Knowledge, Skills, and Abilities :

  • Strong problem-solving capabilities.
  • Excellent customer service / support skills.
  • Excellent verbal and written communication skills.
  • Excellent attendance and punctuality.
  • Ability to effectively communicate in a professional manner.
  • Ability to be flexible, respectful, and calm.
  • Ability to adapt to new and changing situations.
  • Ability to think under pressure and act accordingly.
  • Ability to work independently or as part of a team.
  • Company Description

    At Comp-X Medical Management, we are dedicated to evolving healthcare networks to better serve providers and members. Our mission is to streamline provider engagement processes, improve relationship management, and drive better outcomes for all stakeholders. Leveraging innovative platforms and efficient workflows, we help create a more connected and impactful healthcare system.

    Comp-X Medical Management is committed to providing the highest quality of service available in the industry. Our vision is to continuously set the standard of excellence in the ancillary service market. We listen to our customers and demonstrate our abilities in the areas that matter most to them. We offer a singular solution to help our customers maximize their performance and mitigate their risk. Comp-X offers live customer support 24 / 7 / 365. We believe that outsourcing customer service to overseas call centers makes for a poor client experience. Comp-X is proud to have a customer service team that’s 100% based in the United States.

    Company Description

    At Comp-X Medical Management, we are dedicated to evolving healthcare networks to better serve providers and members. Our mission is to streamline provider engagement processes, improve relationship management, and drive better outcomes for all stakeholders. Leveraging innovative platforms and efficient workflows, we help create a more connected and impactful healthcare system. Comp-X Medical Management is committed to providing the highest quality of service available in the industry. Our vision is to continuously set the standard of excellence in the ancillary service market. We listen to our customers and demonstrate our abilities in the areas that matter most to them. We offer a singular solution to help our customers maximize their performance and mitigate their risk. Comp-X offers live customer support 24 / 7 / 365. We believe that outsourcing customer service to overseas call centers makes for a poor client experience. Comp-X is proud to have a customer service team that’s 100% based in the United States.

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