Clinical Quality Analyst

JOB SUMMARY

The Clinical Quality Analyst plays an integral role in the review process as they are responsible for communicating with the customer, reviewer, and management to ensure a completed report is delivered by the customer requested due date.

In addition to the duties of the Quality Analyst, the Clinical Quality Analyst is also responsible for ensuring that the clinical content is accurate and adequate and serves as a resource for the QAs who are not medically trained when they have questions about medical content.

Dane Street’s success relies on individual and team contributions every day. We care for our customers, each other and Dane Street. It is the responsibility for all of us to maintain a positive working environment that promotes client satisfaction and results.

MAJOR DUTIES & RESPONSIBILITIES

Board Management

• Manage all referrals, assigned to a reviewer, within the division assigned.
• Review all assigned referrals daily to ensure customer specific tasks have been completed or escalated, per process.
• Ensure company-specific best practices have been completed or escalated on all referrals daily, per process.
• Timely delivery of the final report

Escalations

• Responsible for escalating any occurrence, per referral, that falls outside of previously established customer, company, or departmental requirements to the appropriate entity.
• Responsible for following all previously established customer, company, and departmental escalation procedures.

Communication

• Communicates with reviewers, customers, and internal employees, verbally and via email, professionally in compliance with all established formats and policies.

Reviewer Report

• Reviews completed physician reports to ensure the report has met all customer and company requirements.
• Reviews associated records to ensure the reviewer has addressed each pertinent record according to best practices.
• Ensures each report provides a document listing, sorted medical records, clinical summary, rationale, and a response to each listed question.
• Responsible for correcting any spelling/Grammar errors found in the report.
• Obtains any clarifying statements from the reviewer for deficient reports.
• Delivers the final report in the format previously requested by the customer.

Invoicing

• Follows previously established invoicing instructions to determine the final charge to the customer.
• Delivers the final invoice with the completed report via AccessDS.

Clinical Duties

• Performs an independent analysis of a claimant’s medical records (“Nurse Review”) for our clients, when requested.
• Serves as an additional level of QA for cases with Quality Issues.

Additional Duties

• May provide oversight to the work of the team members.
• Provides remediation in training to existing QAs as well as ongoing education.
• Performs case assignment to QA contractors.
• Responsible for the final approval on cases for release to the client.

Other duties & special projects, as assigned and based on business needs.

EDUCATION/CREDENTIALS:

• Active Registered Nurse is required.
• An Associate’s Degree or Bachelor’s Degree is preferred.

JOB RELEVANT EXPERIENCE:

Business experience in a healthcare and/or insurance setting is preferred.

JOB RELATED SKILLS/COMPETENCIES:

Present exceptional communication skills with a clear understanding of company business lines. The ability to apply critical thinking, manage time efficiently and meet specific deadlines. Computer literacy and typing skills are essential.

WORKING CONDITIONS/PHYSICAL DEMANDS:

Any lifting, bending, traveling, etc. required to do the job duties listed above. Long periods of sitting and computer work.

WORK FROM HOME TECHNICAL REQUIREMENTS:

Supply and support their own internet services.

Maintaining an uninterrupted internet connection is a requirement of all work from home position.

This job description is subject to change at any time.

Benefits

We offer generous Paid Time Off, an excellent benefits package, and a competitive salary. If you want to work in an exciting, fast-paced environment where you can provide meaningful contributions, then we encourage you to apply.