Nurse, Customer Support

York Risk Services Group is a premier provider of insurance, risk management, alternative risk, pool administration and claims management solutions to clients across hundreds of industries. Recently named by Forbes as one of "America's Best Midsized Companies Two Years in a Row" We firmly believe that our employees drive the success of the company. With success in mind as the ultimate goal, we strive to create and provide an environment that offers challenging, stimulating and financially rewarding opportunities.

Job Description

Summary:

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.

Responsibilities:

• Ensure that turnaround times are met with a quality review.

• Draw on a wide range of clinical expertise to edit/provide credible case narratives in response to client questions.

• 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.
• Participate in preceptorship and training of new and existing staff as assigned by management.

• Other duties as assigned.

• 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