Qualified NCLEX RN/ USRN Experience in US healthcare process Must have experience in handling teams Must have experience in handling client feedback and escalations Familiarity with basic medical terminology and concepts used in care management Implements clinical policies & procedures in accordance with NCQA, URAC, state and federal standards and mandates Effectively forecast and manage the process volume, allocation, and staffing following the Statement of Work on a daily basis Maintain accurate reporting and cascading of information to internal and external stakeholders Update mandatory process trackers and files for compliance purposes