Job Summary
A company is looking for a Manager I - CQE Acupuncture to join their Clinical Quality Evaluation department.
Key Responsibilities
- Manage medical necessity reviews of acupuncture services
- Conduct timely and accurate reviews to verify medically necessary care for health plan members
- Collaborate with various departments on clinical programs and policy development
Required Qualifications
- Professional degree in Acupuncture from an accredited institution
- Current, unrestricted license to practice acupuncture in California
- Minimum of 5 years of clinical experience, preferably with medical necessity case review
- Understanding of acupuncture practice guidelines and best practices
- Ability to independently resolve clinical determination issues using good judgment
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