Quality Analyst (Remote, LPN Required)

Proficient in both written and spoken communication. Capable of maintaining professional communication with physicians and clients. Skilled at handling multiple tasks and adjusting swiftly in a dynamic setting. Possesses a keen organizational sense and pays close attention to details. Adept at resolving intricate and multifaceted problems. Experienced with Microsoft tools such as Word, Excel, PowerPoint, and Outlook. Background in medical or clinical practice through education, training, or professional engagement. Holds an unrestricted LVN/RN license from an accredited vocational nursing program or a nursing degree from an accredited college. 2 yrs minimum clinical nursing experience. One year of previous experience in Utilization Management. Demonstrate strong abilities in both spoken and written communication, along with effective interpersonal skills. Possess a proficient understanding of computer operations, particularly the Internet, Microsoft Word, Microsoft Access, Microsoft Excel, and Windows. Show the capability to acquire new skills and competencies to address evolving requirements.

Conduct assessments of medical services to validate appropriateness using established criteria. Examine and evaluate patient records to verify quality of care and necessity of services. Offer clinical expertise and serve as a clinical reference for non-clinical staff. Input and manage essential clinical details within medical management platforms. Keep up-to-date with regulatory prerequisites for utilization review. Apply clinical reasoning to determine suitable evidence-based guidelines. Foster efficient and high-quality patient care by communicating with management, physicians, and the Medical Director. Provide oversight to team members. Continuously improve processes for better turnaround time and client satisfaction. Responsible for final approval on cases for release to the client. Act as a liaison and coordinate quality issue reports with the VP of Clinical Operations.