Quality Analyst (Remote, LPN/RN Required)

2 hours, 18 minutes ago
Full-time
Mid Level
Quality Assurance and Testing
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

Description

  • Review medical records, treatment plans, and patient information to determine the necessity and appropriateness of services.
  • Conduct utilization reviews using established criteria and evidence-based guidelines such as CMS, Milliman Care Guidelines, InterQual, or health plan-specific criteria.
  • Evaluate patient records to verify the quality of care and support appropriate care pathways.
  • Provide clinical expertise as a reference for non-clinical staff members.
  • Enter and manage clinical information in medical management platforms.
  • Stay current on utilization review regulations and standards, including URAC and state requirements.
  • Communicate findings and recommendations with management teams, physicians, and the Medical Director.
  • Support process improvements that improve turnaround time, peer-to-peer success rates, and client satisfaction.
  • Provide oversight to team members and complete final approval on cases for client release.
  • Coordinate quality issue reports and new reviewer reports with the VP of Clinical Operations.

Requirements

  • Active, unrestricted LVN/LPN license from an accredited vocational nursing program or a nursing degree from an accredited college for RNs.
  • Minimum of 2 years of clinical nursing experience.
  • Minimum of 1 year of Utilization Management experience.
  • Strong written and verbal communication skills.
  • Ability to communicate professionally with physicians and clients.
  • Ability to manage multiple tasks in a dynamic office environment.
  • Strong organizational skills and close attention to detail.
  • Ability to solve complex and multifaceted problems.
  • Proficiency with Microsoft Word, Excel, PowerPoint, Outlook, and Access, plus general computer and internet use.
  • Background in medical or clinical practice through education, training, or professional experience.
  • Ability to learn new systems, software, and hardware as requirements evolve.
  • Ability to maintain an uninterrupted internet connection for a work-from-home position.

Benefits

  • Salary range of $45,000 to $70,000 USD.
  • Health insurance benefits, including medical, dental, and vision coverage.
  • Retirement plan with company match.
  • Performance bonuses.
  • Basic life insurance, short-term disability, and long-term disability coverage at no cost.
  • Voluntary life, hospital indemnity, critical illness, accident indemnity, and pet insurance options.
  • Generous paid time off.
  • Remote-work support including Apple equipment and a media stipend.

Interested in this position?

Apply directly on the company website

Apply Now

Similar Roles

Ads Quality Rater - Dutch (Netherlands)

Welocalize 1K-5K Professional Services

Welo Data is hiring a freelance, remote Ads Quality Rater in the Netherlands to review and evaluate online advertisements in English and Dutch to improve their relevance and quality for end users.

Deep Learning
3 minutes ago

*Scout Junior Quality Coordinator - Spanish (Mexico)

Welocalize 1K-5K Professional Services

Welocalize is hiring a remote Junior Quality Coordinator in Mexico to support its Search Quality Rater project by reviewing performance, coordinating quality tasks, and assisting with training and communication.

3 minutes ago

Data QA Engineer

Dreamix 51-250 Internet Software & Services

Dreamix is seeking an experienced Data QA Engineer to own quality across its data products by validating pipelines, reporting on risks and defects, and supporting release decisions.

Agile AWS Azure CI/CD JIRA JSON Python Scrum SQL
18 minutes ago

AutoContour Quality Assurance Manager

Radformation 51-250 Internet Software & Services

Radformation is hiring a remote AutoContour Quality Assurance Manager to lead testing, validation, and documentation efforts that ensure its radiation oncology software meets clinical and regulatory standards before release.

C# Visual Studio
48 minutes ago

You're on a roll! Sign up now to keep applying.

Sign Up

Already have an account? Log in

Used by 14,729+ remote workers