Group Health Clinical QA Supervisor

🕒 Março 10

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Dane Street

SiteLinkedInTodas as Vagas

51 - 200 funcionários

⚕️ Seguro de Saúde

📋 Conformidade

🏛️ Governo

Healthcare Insurance • Compliance • Government

A Dane Street é líder nacional em Exames e Revisões Médicas Independentes, fornecendo Exames Médicos Independentes (IMEs), Revisões por Pares e outros laudos médicos de forma objetiva, em conformidade e dentro dos prazos. Com uma ampla rede de mais de 16. 000 médicos, a empresa oferece serviços em 25. 000 localidades e 100 especialidades, incluindo sinistros de compensação trabalhista (Workers’ Compensation), automóvel, responsabilidade civil (Liability) e incapacidade (Disability). A Dane Street atende seguradoras, Third-Party Administrators (TPAs), organizações de Managed Care e órgãos federais/estaduais com análises médicas especializadas, ajudando-os a tomar decisões precisas. A empresa é reconhecida pela qualidade, prazos de entrega ágeis e processos eficientes, tendo conquistado credenciais como a Acreditação da NCQA em Utilization Management e a certificação Great Place to Work.

Descrição

• The Clinical QA Supervisor is responsible for the oversight of the review of Physician reports and accompanying medical records to ensure that the report is complete, accurate, and consistent with medical evidence. • Oversight of QA staff • - Ensure appropriate QA staff are assigned to each file to designate file handling responsibilities amongst the team. • - Supervise the assigned staff and manage the File Review Board to ensure a timely and accurate process of each file. • - Provide details of board reviews to managers to ensure efficiency and productivity of staff. • - Assist in identifying & correcting staff performance including promotions, discipline, coaching and termination of staff. • - Assist in hiring qualified candidates for QA open positions. • Ensure that all QA staff adhere to and meet their specific job duties including but not limited to: • - Following up with Physicians for outstanding reports • - Reviewing received reports for accuracy • - Delivering completed reports back to all applicable parties • - Following all client-specific instructions • - Actively participate in issue resolution by working with the required QA, physicians, account managers, and/or other related parties. • - Ensure referrals meet the client-directed Turn Around Time (TAT). • - Act as the liaison between the reviewer, team member and client regarding the process or status of the file. • - Other duties & special projects, as assigned and based on business needs.

🎯 Requisitos

• EDUCATION/CREDENTIALS: • An Associate’s Degree or Bachelor’s Degree is preferred. • **RN licensure required **** • JOB RELEVANT EXPERIENCE: • Medical peer review or healthcare industry knowledge required. • 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.

🏖️ Benefícios

• Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.