Utilization Management QA RN

🕒 6 days ago

🇺🇸 United States – Remote

💵 $65k - $85k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔧 QA Engineer (Quality Assurance)

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HealthEdge

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2005

⚕️ Healthcare Insurance

☁️ SaaS

💳 Fintech

Healthcare Insurance • SaaS • Fintech

HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.

📋 Description

• Assisting in organizing and facilitating strategic program creation • Providing in-depth analysis on current processes and implementation • Performing QA audits on completed prospective and concurrent reviews • Developing and delivering targeted education for the team related to policies and procedures • Maintaining comprehensive knowledge of business, products, corporate organizational structure • Performing quality audits on calls to ensure adherence to guidelines • Assisting in monitoring initiatives, outcomes, and objectives • Developing lines of communication to discuss/review results of analysis to management • Investigating and recommending innovative solutions for problems • Assisting in developing plans, reports, papers, or other material as needed • Researching and evaluating data to identify discrepancies and trends.

🎯 Requirements

• 2+ years’ experience in US Healthcare in utilization management and/or Quality Assurance review • HealthEdge HRCM, JIRA or Guiding Care experience is a plus • Strong analytical, planning, problem solving, verbal, and written skills to communicate complex ideas • Strong knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.) • Ability to work independently, within a team environment, and communicate effectively with employees and clients at all levels • Flexibility and ease with changing tasks and priorities • Detail oriented • Performing technical tasks such as creating business requirements documents and user training manuals and guides. • Verifies accuracy, consistency, and integrity of data; consults with the operations teams to validate content of reports and documents.

🏖️ Benefits

• Health insurance • Retirement plans • Paid time off • Flexible work arrangements • Professional development