Nurse, Quality Analyst I

Employer
York Risk Services Group
Location
Clearwater, Florida
Salary
Not Specified
Posted
Feb 24, 2019
Closes
Apr 20, 2019
Ref
6363480#GIJtoGJS.2
Industry
Insurance
Category
Insurance

At York, we believe that an experience marked by expertise, consistency and compassion sets us apart. And we celebrate the diverse backgrounds and unique perspectives that allow us to stand apart from our competitors. Thats why we are committed to recruiting, developing and retaining people who represent our values and who believe in our mission.

Job Description

  • Responsible for the quality assurance of clinical reviews by reviewing cases completed by the physician consultants. Interact with clients, physician/allied health reviewers and all levels of company personnel.
  • Draw on a wide range of clinical expertise to edit/provide credible case narratives in response to client questions.
  • Ensure that turnaround times are met with a quality review.
  • Communicate with clients and expert reviewers, as necessary to track reviews. Follow-up with the client for input/clarification concerning the case review.
  • Perform and maintain accurate computer case records.
  • Act as a Liaison between the Physician/Allied Health Reviewers, Account Managers and Customer Service Representatives to ensure that daily operations are client-specific.
  • Participate in the continuous quality improvement (CQI) process by identifying and reporting quality issues as established by existing protocol.
  • Work with management to oversee, monitor and improve quality of services provided in all business lines. This includes participating in policy and procedure development for the case review program.
  • Other duties as assigned.

Qualifications:

Skills
  • Computer skills required
  • Able to set multiple priorities
  • Able to work in a fast paced environment
  • Proven decision making abilities
  • Excellent written and verbal communication skills
  • Excellent interpersonal skills
  • Excellent Problem solving skills
  • Excellent Client Relation Skills
  • Excellent customer service skills

Experience

  • Nursing degree highly preferred, LPN or LVN
  • 1+ industry related experience (specifically UM) preferred
  • 3+ years relevant clinical experience preferred
  • Experience in utilization review/health care industry helpful

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