Utilization Management Review Nurse (11:00A-7:30P Shift)

Description

Dane Street is looking for highly motivated candidates to join our team as a Clinical Quality Assurance Specialist. Dane Street offers an exciting work environment, competitive compensation and a strong growth potential.

Job Summary:

As a Clinical Quality Assurance Specialist, you apply your clinical knowledge to review reports accompanying medical records to ensure that the report is complete. You will communicate with physician reviewers and their office teams to ensure clarity of information and to ensure all questions posed have been addressed, and to ensure that reports are returned within client deadlines.

Shift Available:

**Monday-Friday, 11:00 am-7:30 pm EST**

Core Duties & Responsibilities:

• Provides clinical oversight to cases that are complex and need additional review prior to return to the client.
• Read & apply policy guidelines, healthcare terminology and delineate when criteria is/is not met.
• Ensures that the clinical rationale supports the physician’s determinations.
• Provides strong customer service skills and works closely with clients on a case-by-case basis to provide complete, timely and error free quality assurance of cases.
• Serves as an additional level of QA and clinical knowledge/review for cases with quality Issues.
• Evaluates the quality of the physician's report and determines if the report will meet all client and jurisdictional standards.

Requirements

Required Education & Experience:

• Experience working in a remote environment is preferred.
• Utilization Management experience is strongly preferred.
• Must be a graduate of an accredited LPN, LVN or RN program.
• Experience in a medical office or health care background.

Required Skills:

• Must work with a sense of urgency and meet deadlines.
• Must be self-motivated, with a strong drive for performance excellence.
• Excellent written and verbal communication skills are required.
• Attention to detail REQUIRED.
• Proficiency in navigating a variety of computer programs (Experience with Google Chrome, Gmail, Docs, Sheets, etc. is a plus).

PLEASE BE AWARE: In the interest of the security of both parties, please be aware that Dane Street will never conduct an interview via text or request checks from candidates for purchasing equipment.

Benefits

We offer generous Paid Time Off, excellent benefits package and a competitive salary. Apple equipment and media stipend is provided for remote work space. Come up to speed quickly with our strong training program! If you want to work in an exciting, fast-paced environment where you can provide meaningful contributions, then we encourage you to apply.

ABOUT DANE STREET:

A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful, astute forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers and Pharmacy Benefit Managers. We provide customized Independent Medical Exam and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

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