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HealthEdge

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Utilization Management QA RN

QA EngineerQA EngineerFull TimeRemoteMid LevelTeam 1,001-5,000Since 2005H1B SponsorCompany SiteLinkedIn

Location

United States

Posted

140 days ago

Salary

$65K - $85K / year

Seniority

Mid Level

Bachelor Degree2 yrs expEnglish

Job Description

Utilization Management QA RN

HealthEdge

• Assisting and in organizing and facilitating strategic program creation • Providing in-depth analysis on current processes and implementation • Assisting in researching and compiling appropriate and relevant data and feedback for risk activities • Performing QA audits on completed prospective and concurrent reviews of inpatient, outpatient, ambulatory and ancillary services • Developing and delivering targeted education for the team related to policies, procedures, benefits when appropriate • Maintaining comprehensive knowledge of business, products, corporate organizational structure • Performing quality audits on calls • Assisting in monitoring initiatives, outcomes, and objectives to ensure goal attainment • Developing lines of communication to discuss/review results of analysis to management via reports/presentations • Assisting leadership by investigating, reviewing, and recommending innovative solutions • Assisting in identifying resolution of challenges and issues to fulfill key corporate objectives

Job Requirements

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

Benefits

  • Health insurance
  • 401(k) matching
  • Paid time off
  • Flexible work arrangements

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