[Hiring] Quality Review Manager @IME RESOURCES LLC

Role Description

The Quality Review Manager is responsible to work autonomously to complete full audit, review and approval of the following, but not limited to:

• Life Care Plans
• Medical Cost Projections
• Medicare Set-Aside Allocations
• Legal Nurse Reviews
• Complex Nurse Reviews
• Bill Reviews
• Initial and progress reports for medical or vocational case management files
• Other reports as needed within the scope of nursing practice and certifications

The Quality Review is responsible to monitor the overall quality of all the work products and effectively communicate with the planner team to include development of alternative treatment plans or recommendations for moving the file toward maximum resolution at the highest level of quality and timeliness possible.

Qualifications

• Associates degree required; Bachelor’s degree in health-related field preferred
• Three to five years Medicare Compliance preferred
• Minimum of three years worker’s compensation experience
• Active unrestricted Registered Nursing license
• Minimum active certification in Medicare Set-Asides; additional certification in Life Care Planning and/or Legal Nurse Consulting preferred

Requirements

• Knowledge of the disability and workers' compensation industry including rules and regulations
• Understanding of clinical procedures and all processes involved in the delivery of quality health care to an injured worker
• Adequate operation of a general computer and telephone
• Strong knowledge of multiple software programs, including Microsoft Word, Outlook, Excel, and the Internet
• Knowledge of current laws and regulations that govern delivery of rehabilitation services
• Knowledge of human behavior and performance
• Strong customer service knowledge including needs assessment and evaluation of customer satisfaction
• Exceptional communication skills
• Ability to work independently and prioritize work activities
• Ability to concentrate and multitask in a fast-paced work environment
• Demonstrate accuracy and thoroughness
• Maintain confidentiality
• Promote a positive team-oriented environment
• Work well under pressure and manage change appropriately
• Follow all company policies and procedures

Benefits

• Participate in company orientation, management meetings and/or conference calls as required
• Ensure adherence to all federal Centers for Medicare and Medicaid Services (CMS) requirements and/or state mandates
• Provide insight and direction to management on report quality and compliance
• Promote effective and efficient utilization of company resources
• Participate in various educational and/or training activities as required
• Perform other duties as assigned

Company Description

General company description goes here.