UM QA RN

HealthEdge•Remote,

4d•$65,000 - $85,000•Remote

About The Position

The UM QA RN is responsible for assisting in organizing and facilitating strategic program creation, providing in-depth analysis on current processes and implementation. This role assists in researching and compiling appropriate and relevant data and feedback for risk activities. The UM QA RN performs QA audits on completed prospective and concurrent reviews of inpatient, outpatient, ambulatory and ancillary services to ensure accuracy of documentation, process, and quality. They develop and deliver targeted education for the team related to policies, procedures, and benefits. The role maintains comprehensive knowledge of business, products, corporate organizational structure, and performs quality audits on calls to ensure accuracy and adherence to guidelines. This position assists in monitoring initiatives, outcomes, and objectives, and in developing lines of communication to discuss and review analysis results with management. They also assist leadership by investigating, reviewing, and recommending innovative solutions, identifying problems and root causes, and resolving challenges to fulfill key corporate objectives. Additionally, the UM QA RN assists in the development of plans, reports, papers, and other materials, and supports UAT and other implementation tasks. They research and evaluate data from different sources to identify discrepancies and patterns, and analyze assigned problems to evaluate existing and potential trends and issues. The UM QA RN maintains comprehensive knowledge of business, products, programs, corporate organizational structure, and basic research principles/methodologies. This position description identifies the responsibilities and tasks typically associated with the performance of the position, and other relevant essential functions may be required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990. Candidates may be required to go through a pre-employment criminal background check.

Requirements

2+ years’ experience in US Healthcare in utilization management and/or Quality Assurance review.
Strong analytical, planning, problem solving, verbal, and written skills to communicate complex ideas.
Strong knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.).
Ability to work independently, within a team environment, and communicate effectively with employees and clients at all levels.
Flexibility and ease with changing tasks and priorities.
Detail oriented.
Performing technical tasks such as creating business requirements documents and user training manuals and guides.
Verifies accuracy, consistency, and integrity of data; consults with the operations teams to validate content of reports and documents.

Nice To Haves

HealthEdge HRCM, JIRA or Guiding Care experience is a plus.

Responsibilities

Perform QA audits on completed prospective and concurrent reviews of inpatient, outpatient, ambulatory and ancillary services to ensure accuracy of documentation, process, and quality.
Develop and deliver targeted education for the team related to policies, procedures, benefits when appropriate.
Perform quality audits on calls, ensure that information provided during call is accurate and adheres with all guidelines.
Assists in monitoring initiatives, outcomes, and objectives to ensure goal attainment within defined parameters.
Assists in development of lines of communication to discuss/review results of analysis to management via reports/presentations and assists management in implementing programs that provide solutions.
Assists leadership by investigating, reviewing, and recommending innovative solutions which identify problems/root cause of issues.
Assists in identifying resolution of challenges and issues to fulfill key corporate objectives and responds to the demands of change management and initiates actions needed to plan, organize, and control team activities.
Assists in development of plans, reports, papers, and/or other material creation as needed.
Assists with UAT and other implementation tasks as needed.
Research and evaluate data from different sources to identify discrepancies and patterns.
Assists in the research, analysis, identification, and evaluation of data from assigned problems to evaluate existing and potential trends and issues.