Job DetailsJob Location: Rockford, IL 61108Position Type: Full TimeSalary Range: $45.00 - $52.00 HourlyAre you passionate about clinical quality, accuracy, and continuous improvement -and looking for a role that allows you to make a meaningful impact while working from home? We’re seeking a Utilization Review & Quality Assurance Specialist to join our fully remote team. This role offers a consistent 8:00am-4:30pm EST schedule, providing structure and work-life balance while you contribute to high‑quality clinical review operations. In this role, you’ll be at the center of ensuring excellence - leveraging strong knowledge of group health plans, clinical criteria sets, leadership, and change management to review clinical documentation, uphold regulatory and client standards, and drive quality across medical review processes. Responsibilities may include: Evaluate clinical information received, write and/or review various reports including, but not limited to: Medical Record Reviews, Medical Record Chronologies, Provider Bill Reviews, Coding Reviews, Hospital Bill Reviews, List of Missing Records, Medical Bill Apportionments, Mock Billing Invoice and Medical Summary Statements. Perform quality assurance reviews of peer review reports, correspondences, addendums or supplemental reviews to ensure they meet company standards for content, clarity, evidence-based rationale, formatting, and professional presentation. Ensure all client instructions and specifications have been followed, all questions have been answered, and all recommendations or determinations are supported by clear, concise, and evidence-based rationales. Verify that each review includes appropriate clinical citations when applicable, and ensure all references cited are current and obtained from reputable medical journals and publications. Identify inconsistencies within reports and contact the reviewer to obtain clarifications, modifications, or corrections needed. Assist in the resolution of customer complaints and quality assurance issues as appropriate. Ensure all federal ERISA and applicable state mandates are adhered to. Provide ongoing feedback and recommendations to management regarding consultant performance, quality trends, and compliance with internal and client specific requirements. Participate in the development and implementation of policies and procedures to improve efficiency and quality across operations. Develop and lead formal and informal training sessions -individually or in groups -that promote high-quality utilization review practices and reinforce company standards. Develop and document new or improved operational processes to support continuous improvement. Promote effective and efficient utilization of company resources across all responsibilities. Participate in or lead various continuing education and training activities related to clinical knowledge, industry standards, and company processes. Perform other duties as assigned. Qualifications Must hold and maintain a Registered Nursing License. Strong knowledge of group health/criteria sets/leadership/change management. Must have strong understanding of medical terminology, anatomy and physiology, treatment protocols, medications and laboratory values. Must be proficient in Microsoft Office Suite, Outlook, internet navigation and general office equipment. Must have the ability to follow instructions and respond to upper managements’ directions accurately. Ability to work independently, prioritize tasks, and manage time efficiently in a fast-paced environment. Ability to demonstrate accuracy, thoroughness, and commitment to producing high quality work; actively monitor own performance and seek opportunities for improvement. Ability to demonstrate flexibility and remain composed under pressure or in stressful conditions; adapts well to change and promotes a positive team environment. Must be able to maintain confidentiality. Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time. ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages. Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws. Equal Opportunity Employer - Minorities/Females/Disabled/Veterans ExamWorks offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.

Job DetailsJob Location: Rockford, IL 61108Position Type: Full TimeSalary Range: $45.00 - $52.00 HourlyAre you passionate about clinical quality, accuracy, and continuous improvement -and looking for a role that allows you to make a meaningful impact while working from home? We’re seeking a Utilization Review & Quality Assurance Specialist to join our fully remote team. This role offers a consistent 8:00am-4:30pm EST schedule, providing structure and work-life balance while you contribute to high‑quality clinical review operations. In this role, you’ll be at the center of ensuring excellence - leveraging strong knowledge of group health plans, clinical criteria sets, leadership, and change management to review clinical documentation, uphold regulatory and client standards, and drive quality across medical review processes. Responsibilities may include: Evaluate clinical information received, write and/or review various reports including, but not limited to: Medical Record Reviews, Medical Record Chronologies, Provider Bill Reviews, Coding Reviews, Hospital Bill Reviews, List of Missing Records, Medical Bill Apportionments, Mock Billing Invoice and Medical Summary Statements. Perform quality assurance reviews of peer review reports, correspondences, addendums or supplemental reviews to ensure they meet company standards for content, clarity, evidence-based rationale, formatting, and professional presentation. Ensure all client instructions and specifications have been followed, all questions have been answered, and all recommendations or determinations are supported by clear, concise, and evidence-based rationales. Verify that each review includes appropriate clinical citations when applicable, and ensure all references cited are current and obtained from reputable medical journals and publications. Identify inconsistencies within reports and contact the reviewer to obtain clarifications, modifications, or corrections needed. Assist in the resolution of customer complaints and quality assurance issues as appropriate. Ensure all federal ERISA and applicable state mandates are adhered to. Provide ongoing feedback and recommendations to management regarding consultant performance, quality trends, and compliance with internal and client specific requirements. Participate in the development and implementation of policies and procedures to improve efficiency and quality across operations. Develop and lead formal and informal training sessions -individually or in groups -that promote high-quality utilization review practices and reinforce company standards. Develop and document new or improved operational processes to support continuous improvement. Promote effective and efficient utilization of company resources across all responsibilities. Participate in or lead various continuing education and training activities related to clinical knowledge, industry standards, and company processes. Perform other duties as assigned. Qualifications Must hold and maintain a Registered Nursing License. Strong knowledge of group health/criteria sets/leadership/change management. Must have strong understanding of medical terminology, anatomy and physiology, treatment protocols, medications and laboratory values. Must be proficient in Microsoft Office Suite, Outlook, internet navigation and general office equipment. Must have the ability to follow instructions and respond to upper managements’ directions accurately. Ability to work independently, prioritize tasks, and manage time efficiently in a fast-paced environment. Ability to demonstrate accuracy, thoroughness, and commitment to producing high quality work; actively monitor own performance and seek opportunities for improvement. Ability to demonstrate flexibility and remain composed under pressure or in stressful conditions; adapts well to change and promotes a positive team environment. Must be able to maintain confidentiality. Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time. ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages. Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws. Equal Opportunity Employer - Minorities/Females/Disabled/Veterans ExamWorks offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.

• Provide expertise in business process and system analysis and design • Collaborates with stakeholders and product teams to decompose large epics into features and user stories that can be understood and approved by members of the development team • Envision, develop, and create requirements to improve tools to streamline processes to gain efficiencies and improve key metrics • Meeting with product design team to determine testing parameters • Ensure that developed user stories are completed accurately • Working with teams to bring continuous improvement to DevSecOps processes and tools • Engineering and implementing solutions and providing recommendations for continuous improvement for the services provided • Creating and executing test plans, test cases, and test scripts for accessibility validation • Managing test data architecture definition • Providing validation testing of different system and data sets for cloud migrations • Testing and examining code written by others and analyzing results, including three or more of the following: Data validation testing, Functional testing, Performance and load testing, Usability testing, Accessibility (508) testing of web and mobile applications to ensure compliance with Section 508, WCAG 2.1 • Troubleshooting errors and streamlining the test procedures • Use JIRA as agile lifecycle tool, along with SalesForce functional and administrative features • Automating and improving development, testing, deployment, and release processes • Documenting as-is state of the environment, performing a gap analysis, and producing artifacts that articulate options and recommendations • Utilizing tools such as Axe, JAWS, NVDA, VoiceOver, and other assistive technologies to assess accessibility • Acting as an individual contributor and mentor more junior team members

DARE TO BE A PART OF THE CHALLENGE! COME AND JOIN OUR TEAM TOGETHER WE CAN MAKE THE DIFFERENCE! Did you know that Accenture is leading the digital transformation in the World? Accenture is a leading global professional services company, providing a broad range of services and solutions in strategy, consulting, digital, technology and operations. Our main purpose is to collaborate with our clients, so they can become high-performance businesses. Accenture is present in more than 200 offices, 120 cities, 56 countries and approximately 640,000 employees worldwide. We Offer - Career development according to your profile and interests. - Work in one of the best companies and feel proud. - Access to an innovative methodology and tools. - Direct contact with experts worldwide. - Use of work schemes and cutting-edge technologies. - Constant training. - Work environment based on teamwork and collaboration. - Participation in International Project. THE WORK: Discover the opportunity to make impactful decisions and provide effective solutions that resonate across multiple groups. You will collaborate closely with various teams and contribute to key decisions, while managing and guiding others to perform at their best. This role will engage your expertise in SRE Assessment, fostering an environment where innovation and problem-solving thrive. Join us and be part of a journey that values your insights and dedication. Ensure production systems are available and operating according to defined service level agreements. Drive incident and outage resolution with clear communication to all relevant parties. Facilitate the restoration of service to the production environment efficiently and effectively. Establish and maintain disaster recovery procedures to safeguard critical operations. Maintain data retention practices in alignment with organizational policies and compliance requirements. HERE'S WHAT YOU WILL NEED: - Advanced proficiency in SRE Assessment. - Advanced proficiency in SQL Databases. - A minimum of 2 of experience in relevant related skills. - Bachelor's Degree in relevant field of studies. - English intermediate. BONUS POINTS IF YOU HAVE: - Intermediate proficiency in Custom Application Development. - Intermediate proficiency in Software Design & Solutions. - Intermediate proficiency in Software Engineering. - Advanced proficiency in System Monitoring and Alerting. - Intermediate proficiency in Incident Management. About Accenture Accenture is a leading global professional services company that helps the world’s leading businesses, governments and other organizations build their digital core, optimize their operations, accelerate revenue growth and enhance citizen services—creating tangible value at speed and scale. We are a talent- and innovation-led company with approximately 791,000 people serving clients in more than 120 countries. Technology is at the core of change today, and we are one of the world’s leaders in helping drive that change, with strong ecosystem relationships. We combine our strength in technology and leadership in cloud, data and AI with unmatched industry experience, functional expertise and global delivery capability. Our broad range of services, solutions and assets across Strategy & Consulting, Technology, Operations, Industry X and Song, together with our culture of shared success and commitment to creating 360° value, enable us to help our clients reinvent and build trusted, lasting relationships. We measure our success by the 360° value we create for our clients, each other, our shareholders, partners and communities.Visit us at www.accenture.com Declaración de igualdad de oportunidades en el empleo Creemos que nadie debe ser discriminado por sus diferencias. Todas las decisiones de empleo se tomarán sin importar la edad, raza, credo, color, religión, sexo, origen nacional, ascendencia, discapacidad, condición de veterano militar, orientación sexual, identidad o expresión de género, información genética, estado civil, ciudadanía ni ningún otro criterio protegido por la legislación aplicable. Nuestra rica diversidad nos hace más innovadores, competitivos y creativos, lo que nos ayuda a servir mejor a nuestros clientes y comunidades.