Clinical Quality Assurance Analyst

TEKsystems•Rockville, MO

2d•$27 - $29•Remote

About The Position

This role involves double-checking processed information to verify accuracy, including the use of specific surgeons, specialties, and state insurance. The analyst will identify if client requests were met during visits, ensuring services align with policies and criteria, and determining necessity and requirement. The position requires providing these findings and updates to clients, ensuring reports are well-written, grammatically correct, and that clinical information is clear and logical. Communication with clients via phone and email regarding results is essential. The role may involve quick turnaround cases, making time management crucial. The specialization is Workers Comp, with a focus on chronic illness, though broad experience is acceptable.

Requirements

Nursing Degree (RN or LPN) with active credentials.
Great written and phone communication skills.
Clinical knowledge to perform reviews.
Experience in Workers Comp.
Experience in chronic illness is a specific area of focus.

Nice To Haves

Previous remote work experience is a plus.
Broad experience in clinical reviews is well-versed enough.

Responsibilities

Double checking processed information to verify accuracy.
Verifying the correct surgeons and specialties were used.
Confirming if state insurance was used and if it was correct.
Identifying if client requests were met during visits.
Ensuring services met policies and criteria, and were necessary and required.
Providing answers and updates to clients based on review findings.
Writing up reports, ensuring they are well-written, grammatically correct, and that clinical information and explanations make sense.
Providing phone call and email communication to clients about results.
Managing time effectively, especially for quick turnaround cases.