Utilization Management Review Nurse (Thurs - Sun Shift)

Full-Time

Mid Level

Remote

$49.200 - $62.200

12 Sep → 12 Oct

Dane Street

Palm Beach Gardens, FL, USA

About Company

Dane Street is the industry's fastest growing national IME and Peer Review provider with a panel of board-certified, active-practice physicians in all 50 states. Services are provided to the Workers Compensation, Pharmacy, Disability, Group Health and Auto/Liability lines of business.
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Job Description

Dane Street is looking for highly motivated candidates to join our team as a Clinical Quality Assurance Specialist. Dane Street offers an exciting work environment, competitive compensation and a strong growth potential.

Job Summary:

As a Clinical Quality Assurance Specialist, you apply your clinical knowledge to review reports accompanying medical records to ensure that the report is complete. You will communicate with physician reviewers and their office teams to ensure clarity of information and to ensure all questions posed have been addressed, and to ensure that reports are returned within client deadlines.

Shift Available:

**Thursday-Sunday 10-hour shift**

ABOUT DANE STREET:

A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful, astute forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers and Pharmacy Benefit Managers. We provide customized Independent Medical Exam and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

Job Responsibilities

  • Evaluates the quality of the physician's report and determines if the report will meet all client and jurisdictional standards.
  • Ensures that the clinical rationale supports the physician’s determinations.
  • Read & apply policy guidelines, healthcare terminology and delineate when criteria is/is not met.
  • Provides strong customer service skills and works closely with clients on a case-by-case basis to provide complete, timely and error free quality assurance of cases.
  • Provides clinical oversight to cases that are complex and need additional review prior to return to the client.
  • Serves as an additional level of QA and clinical knowledge/review for cases with quality Issues.

Requirements / Qualifications

  • Must be a graduate of an accredited LPN, LVN or RN program.
  • Utilization Management experience is strongly preferred.
  • Experience working in a remote environment is preferred.
  • Experience in a medical office or health care background.
  • Must work with a sense of urgency and meet deadlines.
  • Must be self-motivated, with a strong drive for performance excellence.
  • Excellent written and verbal communication skills are required.
  • Proficiency in navigating a variety of computer programs (Experience with Google Chrome, Gmail, Docs, Sheets, etc. is a plus).
  • Attention to detail REQUIRED.

Benefits/What We offer

  • We offer generous Paid Time Off, excellent benefits package and a competitive salary. Apple equipment and media stipend is provided for remote work space. Come up to speed quickly with our strong training program! If you want to work in an exciting, fast-paced environment where you can provide meaningful contributions, then we encourage you to apply.

How To Apply

Apply through GoRemotely.

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