Senior Nurse, Quality & Accreditation Lead

HealthHelp, LLC; United States; Remoto; USD 80.000 - 90.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical insurance

Dental insurance

Vision insurance

PTO & Holidays

401(k) match

Life insurance

Descrizione del lavoro

HealthHelp is seeking a RN-licensed professional to perform internal and external quality audits of clinical review activities, including interrater reliability and adverse determination notices.

You will provide quality scoring and trend analysis to management, with root cause analysis and recommended corrective actions, while maintaining knowledge of utilization management workflows and policies across programs.

Competenze

• Graduate of an accredited school of nursing with an active, unrestricted RN license in the U.S.
• Minimum of 3 years of utilization management experience at a health plan, UM vendor, or delegated UM organization.
• At least 1 year of quality audit, quality assurance, or compliance audit experience.

Mansioni

• Perform internal and external quality audits of clinical review activities.
• Provide quality scoring and trend analysis to management with root cause analysis and recommended corrective actions.
• Maintain working knowledge of utilization management workflows, systems, and policies for each program audited.

Conoscenze

Quality audits

Utilization management

Interrater reliability

Formazione

Nursing degree (RN)

Descrizione del lavoro

HealthHelp is seeking a RN-licensed professional to perform internal and external quality audits of clinical review activities, including interrater reliability and adverse determination notices.

You will provide quality scoring and trend analysis to management, with root cause analysis and recommended corrective actions, while maintaining knowledge of utilization management workflows and policies across programs.