Transform the landscape of healthcare by leading clinical reviews of member appeals, ensuring compliance and timely determinations while collaborating across departments to enhance organizational initiatives and improve patient outcomes.

Lead the charge in enhancing community health by conducting assessments and providing interventions for members facing social barriers. Collaborate with interdisciplinary teams to ensure effective care and support for vulnerable populations.

Manage clinical reviews of member appeals, ensuring compliance and timely determinations across Medicare and Commercial lines. Collaborate with internal teams and external providers to uphold medical necessity and benefit eligibility standards.

Drive impactful social interventions by assessing health needs and linking members to community resources. Collaborate with interdisciplinary teams to enhance care for Medi-Cal populations, ensuring stability and access to essential services.

Champion regulatory compliance by ensuring timely, accurate filings for health plans. Collaborate with cross-functional teams to guide submissions and maintain audit readiness while managing multiple deadlines in a dynamic environment.