Remote Clinical QA Nurse – Utilization Review Expert

TEKsystems; United States; A distancia; USD 37.000 - 39.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental & vision

401(k) Retirement Plan

Life Insurance

Short and long-term disability

HSA (Health Spending Account)

Time Off/Leave

Employee Assistance Program

Descripción de la vacante

TEKsystems is seeking a Clinical Quality Assurance Nurse / Utilization Review Nurse for a fully remote contract-to-hire role. The position involves ensuring quality and regulatory compliance for case reports and supporting the QA department.

Responsibilities include reviewing peer reports, providing evidence-based rationales, and verifying references and credentials. Strong HIPAA knowledge, medical terminology, and computer skills are essential.

Formación

• Strong knowledge of medical terminology, anatomy and physiology, medications, and laboratory values.
• Must be a qualified typist with a minimum of 40 WPM
• Must have a full understanding of HIPAA regulations and compliance.
• Must be able to operate a general computer, fax, copier, scanner, and telephone.
• Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
• Must demonstrate exceptional communication skills.
• Ability to follow instructions and respond to upper managements directions accurately.
• Must demonstrate accuracy and thoroughness. Look for ways to improve and promote quality and monitors own work to ensure quality is met.
• Must be able to work independently, prioritize work activities and use time efficiently.
• Must be able to maintain confidentiality.
• Must be able to demonstrate and promote a positive team -oriented environment.
• Must be able to stay focused and concentrate under normal or heavy distractions.
• Must be able to work well under pressure and or stressful conditions.
• Must possess the ability to manage change, delays, or unexpected events appropriately.
• Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.

Responsabilidades

• Perform quality assurance review of peer review reports and addendums.
• Provide evidence-based rationales for recommendations and determinations.
• Ensure client instructions and specifications are followed and questions addressed.
• Cite current, reputable medical journals and publications supporting reviews.
• Ensure reports meet high quality standards in content, format, and appearance.
• Verify board specialty review and proper documentation on case reports.
• Verify peer reviewer attestation and absence of conflicts of interest.
• Ensure provider credentials and signature are included in final reports.
• Identify inconsistencies and obtain clarifications from peer reviewers.
• Assist in resolution of client complaints and QA issues.
• Ensure compliance with ERISA and state mandates.
• Provide insights to management on consultant quality and compliance.
• Promote efficient use of company resources.
• Participate in training activities.
• Perform other duties as assigned.

Conocimientos

Medical terminology

Anatomy & physiology

Typing 40 WPM

HIPAA compliance

MS Word

Outlook

Excel

Communication skills

Time management

Quality assurance

Independent work

Confidentiality

Team player

Pressure tolerance

Policy adaptation

Herramientas

Microsoft Word

Outlook

Excel

Descripción del empleo

TEKsystems is seeking a Clinical Quality Assurance Nurse / Utilization Review Nurse for a fully remote contract-to-hire role. The position involves ensuring quality and regulatory compliance for case reports and supporting the QA department.

Responsibilities include reviewing peer reports, providing evidence-based rationales, and verifying references and credentials. Strong HIPAA knowledge, medical terminology, and computer skills are essential.