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Quality Analyst (Remote, LPN Required)

1 month ago
United States
Full-time
Junior
Operations Analyst
Operations
Apply Now
Dane Street

Dane Street

Dane Street provides independent medical examination and peer review services tailored for the insurance industry, focusing on areas such as workers' compensation, disability, and auto liability, while emphasizing quality, compliance, and timely delive...

Insurance
251-1K
Founded 2008
View All Jobs 63

Description

  • Conduct utilization reviews and assess the appropriateness and medical necessity of medical services, tests, and treatments using established criteria and guidelines.
  • Review patient records, treatment plans, and clinical information to verify quality of care and service necessity.
  • Provide clinical expertise as a reference for non-clinical staff and support care-pathway decisions.
  • Enter and manage clinical information in medical management systems and related platforms.
  • Communicate with physicians, management teams, the Medical Director, and patients as needed to support care coordination and review outcomes.
  • Stay current on utilization review regulations, including URAC and state standards, and apply evidence-based guidelines appropriately.
  • Support process improvements that improve turnaround time, peer-to-peer success rates, and client satisfaction.
  • Provide oversight of team members when needed and approve cases for release to the client.
  • Serve as a liaison with the VP of Clinical Operations on quality issue reports and new reviewer reports.

Requirements

  • Active, unrestricted LVN/RN license; LVNs must hold a license from an accredited vocational nursing program, and RNs must hold a nursing degree from an accredited college.
  • Minimum 2 years of clinical nursing experience.
  • Minimum 1 year of previous utilization management experience.
  • Background in medical or clinical practice through education, training, or professional experience.
  • Strong written and verbal communication skills with the ability to communicate professionally with physicians and clients.
  • Ability to multitask, adapt quickly in a fast-paced office environment, and resolve complex problems.
  • Strong organizational skills and attention to detail.
  • Proficiency with Microsoft Word, Excel, PowerPoint, Outlook, and Access, as well as general computer and internet use.
  • Ability to learn new systems, software, and hardware as job requirements evolve.
  • Ability to perform work that may involve lifting, bending, travel, prolonged sitting, and extended computer use.
  • Ability to supply and maintain uninterrupted internet service for a work-from-home position.

Benefits

  • Salary range of $45,000 to $70,000 USD.
  • Comprehensive medical, dental, and vision coverage for employees and their families.
  • Retirement plan with company match.
  • Performance bonuses.
  • Voluntary life insurance options for employees, spouses, and children.
  • Company-paid basic life insurance, short-term disability, and long-term disability coverage.
  • Generous paid time off.
  • Apple equipment and a media stipend for remote work.

Interested in this position?

Apply directly on the company website

Apply Now

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