Remote Utilization Management RN

Job Description

The Clinical Quality Assurance Coordinator is responsible for ensuring case reports are of the highest quality and integrity and in full compliance with client contractual agreements, regulatory agency standards and federal and state mandates.

Essential Job Functions

• Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.
• Ensure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
• Ensure that all client instructions and specifications have been followed and that all questions have been addressed.
• Ensure each review is supported by clinical citations and references when applicable.
• Ensure the content, format, and professional appearance of the reports are in compliance with company standards.
• Ensure the appropriate board specialty has reviewed the case in compliance with client specifications or state mandates.
• Assist in resolution of client complaints and quality assurance issues as needed.
• Ensure all federal ERISA and state mandates are adhered to at all times.

Qualifications

• Utilization Management experience required
• Registered Nurse
• 2-4 years of experience

Pay and Benefits

• Pay range: $26.50 - $28.50/hr
• Benefits include Medical, Dental & Vision, 401(k), Life Insurance, Disability, HSA, and PTO.