Clinical and Regulatory Program Consultant

Overview

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 in the DFW area for a hybrid work schedule

Note:

This section describes the role focus and responsibilities that align with the overview provided above.

An associate degree or Diploma in Nursing is required. Bachelor’s degree in nursing is preferred.

• Minimum 5 years of clinical experience in healthcare settings (managed care, population health, or care management preferred). Strong background in health plan regulatory requirements, including CMS, NCQA, URAC, HIPAA, State and other compliance standards.
• Prior experience in consulting or implementation of healthcare technology solutions is a plus.

• Current and unrestricted US LPN or RN license required.
• CCM or similar certification preferred.

• Hands-on experience using computer systems within Managed Care Organization (MCO), Third-Party Administrator (TPA), or Accountable Care Organization (ACO) environments.
• Experience with Care Management and Population Health Management software preferred.
• Proficient in using a wide range of computer programs, including but not limited to MS Office Suite (Word, Excel, Visio, PowerPoint, Outlook), as well as collaboration and meeting platforms such as Microsoft Teams, Zoom, Web Ex, and Go To Meeting .

• Extensive knowledge of current medical information technology and applications required.
• Must be able to analyse and assess needs in clinical informatics.