Quality Assurance Supervisor – Clinical RN

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🕒 Abril 30

🐊 Florida – Remoto

🐊 Florida – Remote

💵 $95.000 - $105.000 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

🔧 Engenheiro de QA (Qualidade de Software)

🦅 Patrocina Visto H1B

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BASF

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1865

🌾 Agricultura

Chemicals • Agriculture • Healthcare

Na BASF, criamos química para um futuro sustentável. Combinamos sucesso econômico com proteção ambiental e responsabilidade social. Cerca de 112.000 funcionários do Grupo BASF contribuem para o sucesso de nossos clientes em praticamente todos os setores e em quase todos os países do mundo. Nosso portfólio é composto por seis segmentos: Químicos, Materiais, Soluções Industriais, Tecnologias de Superfície, Nutrição & Cuidados e Soluções Agrícolas. A BASF gerou vendas de €68,9 bilhões em 2023. As ações da BASF são negociadas na bolsa de valores de Frankfurt (BAS) e como American Depositary Receipts (BASFY) nos Estados Unidos.

Descrição

• The Supervisor, Quality Assurance (Clinical) leverages their nursing background, clinical review, and experience leading others to manage staff and operational results for a remote team of nurses and other audit roles, performing clinical review audits. • Contributes to positive team environment that fosters open communication, sharing of information, continuous improvement, and optimized business results. • Regularly Performs audit quality assurance reviews to supplement QA team activity as necessary based upon business need or special projects. • Contributes to the resolution of quality review rebuttals. • Actively identifies and recommends opportunities for cost savings and improving outcomes that can have a direct impact to the company's profitability. • Effectively contributes to the development of medical review guidelines and training. • Supports audit management and segment specialists with activities for new concept implementation, maintenance of medical review guidelines for existing concepts. • Use data, reports, and experience to identify potential backlogs and align resources to meet business needs and SLAs. • Collaborate with other departments to resolve operational problems. • Proactively monitors and in alignment with applicable management ensures activity required to meet team staffing levels necessary for assigned business segment objectives. • Provides support as needed to ensure auditors are equipped with tools and resources required to perform audits. • Supervise daily activities of quality assurance team. • Provide audit guidance to QA team; identify trends and present solutions. • Provides production and quality performance-based progress reports, coaching, and constructive feedback to staff. • Manages team Time and Attendance (time off/use of accruals, attendance, attendance points and timecards for hourly staff, etc.) in accordance with applicable policies and procedures. • Collaborates with HR for applicable corrective action as applicable. • Complete and conduct performance reviews for assigned staff. • Routinely review QA scorecards for accuracy and education, QA of the QA. • Conduct team meetings with direct reports on a regular basis. • Provide leadership to team members, provide solutions, and resolve conflicts. • Escalate to management and collaborate with HR as applicable to bring appropriate solutions to employee matters. • Provide reporting and updates to management as required and appropriate for operational and staff activity and results. • Participates in and contributes to applicable department meetings. • May support management with activities to monitor inventory and activity of 3rdparty/subcontractors. • Become subject matter expert for assigned business segment(s). • Maintain current knowledge and changes that affect our industry and clients as it pertains to medical practice, technology, regulations, legislation, and business trends. • May support training material/tools and best practices development. • Identify needs and ensure team receives necessary training. • Support training activities for new audit staff or provide supplemental training for existing staff as needed. • Receives feedback and adjusts work priority for self and team as necessary. • Leads by example and conducts work in accordance with company policies, government regulations and law. • Serves as positive role model and demonstrates characteristics that align and contribute to a collaborative culture of continuous improvement and high performing teams. • Perform other incidental and related duties as required and assigned to meet business needs.

🎯 Requisitos

• 3+ years diverse Nursing experience providing direct care in an inpatient or outpatient setting. • Current active unrestricted Nursing license in good standing, is required (RN license is required for government contract focused positions). • Not currently sanctioned or excluded from the Medicare program by OIG. • 2+ years of performing medical record audits, quality reviews in a provider setting, or in a payer setting for a health insurance company. • Demonstrated experience gathering, researching, and documenting data and requirements for projects and/or complex problem solving. • 3+ years prior experience in supervisory or leadership in similar business environment (preferably experience overseeing remote staff). • 3+ years in health care claims that demonstrates expertise in DRG’s and medical billing experience for an Insurance Company or hospital required. (less than 3 yrs. may be considered for internal candidates based upon demonstrated skills and results). • Medical coding certification is a plus. • Prior experience in payer edit development, and/or reimbursement policy experience a plus.

🏖️ Benefícios

• medical, dental, vision, HSA/FSA options • life insurance coverage • 401(k) savings plans • family/parental leave • paid holidays • paid time off annually