[Hiring] Utilization Management QA RN @HealthEdge

Role Description

The UM QA RN is responsible for assisting and 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.

• 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, and benefits when appropriate.
• Maintain comprehensive knowledge of business, products, corporate organizational structure (including functional responsibilities).
• Perform quality audits on calls, ensuring that information provided during calls is accurate and adheres to all guidelines.
• Assist in monitoring initiatives, outcomes, and objectives to ensure goal attainment within defined parameters.
• Assist in the development of lines of communication to discuss/review results of analysis to management via reports/presentations and assist management in implementing programs that provide solutions.
• Assist leadership by investigating, reviewing, and recommending innovative solutions which identify problems/root cause of issues.
• Assist in identifying resolution of challenges and issues to fulfill key corporate objectives and respond to the demands of change management.
• Assist in the development of plans, reports, papers, and/or other material creation as needed.
• Assist with UAT and other implementation tasks as needed.
• Research and evaluate data from different sources to identify discrepancies and patterns.
• Maintain comprehensive knowledge of business, products, programs, corporate organizational structure (including functional responsibilities), and basic research principles/methodologies.

Qualifications

• 2+ years’ experience in US Healthcare in utilization management and/or Quality Assurance review.
• HealthEdge HRCM, JIRA, or Guiding Care experience is a plus.

Requirements

• 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.

Benefits

• Remote, US.
• Full-time, permanent.
• Exempt (FLSA Classification, USA Only).

Work Environment

• The employee is occasionally required to move around the office.
• Specific vision abilities required include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
• Work across multiple time zones in a hybrid or remote work environment.
• Long periods of time sitting and/or standing in front of a computer using video technology.
• May require travel dependent on company needs.

Salary Information

The annual US base salary range for this position is $65,000 to $85,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications, and education.