Quality Analyst - Utilization Management Nurse Reviewer (LPN Required)
D
Dane Street, LLCHealthcare
United StatesFull-TimeMiddle
Salary45000 - 70000 USD per year
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Job Details
- Experience
- 2 yrs minimum clinical nursing experience is required. One year of previous experience in Utilization Management is required.
- Required Skills
- Microsoft AccessMicrosoft ExcelPowerPoint
Requirements
- 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 office 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 (for LVNs) or a nursing degree from an accredited college (for RNs)
- 2 years minimum clinical nursing experience
- 1 year of previous experience in Utilization Management
- Strong abilities in both spoken and written communication, along with effective interpersonal skills
- Proficient understanding of computer operations, particularly the Internet, Microsoft Word, Microsoft Access, Microsoft Excel, and Windows
- Capability to acquire new skills and competencies to address evolving requirements of systems, software, and hardware
Responsibilities
- Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines
- Examine and evaluate patient records to verify the quality of patient care and the necessity of provided services
- Offer clinical expertise and serve as a clinical reference for non-clinical staff members
- Input and manage essential clinical details within various medical management platforms
- Keep up-to-date with regulatory prerequisites and state standards for utilization review
- Apply clinical reasoning to determine the suitable evidence-based guidelines
- Foster efficient and high-quality patient care by effectively communicating with management teams, physicians, and the Medical Director
- Provide oversight to the work of team members (may)
- Continuously improve processes to facilitate better turnaround time and client satisfaction
- Responsible for the final approval on cases for release to the client
- Act as a liaison and coordinate quality issue reports with the VP of Clinical Operations
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