Quality and Process Improvement Lead

Job not on LinkedIn

🔥 4 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

⚙️ Operations

👻 Ghost score 25%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Dane Street

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

💼 Consulting

⚖️ Legal

Healthcare • Consulting • Legal

Dane Street is a national leader in Independent Medical Exams and Reviews, providing objective, compliant, and timely Independent Medical Examinations, Peer Reviews, and other medical reports. With a large network of over 16,000 physicians, the company offers its services across 25,000 locations and 100 specialties, including Workers' Compensation, Auto, Liability, and Disability claims. Dane Street supports Insurance Carriers, Third Party Administrators, Managed Care Organizations, and Federal/State entities with expert medical analyses, helping them make accurate determinations. The company is recognized for its quality, fast turnaround times, and efficient processes, earning accolades like the NCQA Accreditation in Utilization Management and the Great Place to Work certification.

📋 Description

• Serve as the bridge between internal operations and clients, ensuring compliance with client parameters and quality standards • Partner with client auditors through monthly review calls and calibration sessions • Manage monthly case sample selection, score logging, and deduction-point tracking in the client portal • Lead audit rebuttals by investigating findings and presenting data-backed appeals • Maintain, analyze, and upload quality metrics and audit insights to the client portal • Lead in-person client touchpoints and strategic business reviews • Facilitate coaching sessions for the internal QA team • Analyze audit trends, identify root causes, and recommend process solutions • Oversee post-audit action plans and implementation of process updates and machine-learning enhancements • Collaborate with Machine Learning, client, and operations teams to develop automation rules • Validate machine-learning automations and tool features against live sample data • Conduct internal QA calibration sessions to eliminate scoring variances • Document audit methodologies, case guidelines, and client-specific rules in SOPs • Design CAPA protocols for recurring high-severity errors and compliance failures • Establish reporting cadence for executive leadership covering risks, solutions, and performance gains

🎯 Requirements

• Associate's Degree or Equivalent Experience • Experience in quality assurance, auditing, utilization review, or a related healthcare operations function • Working knowledge of workers’ compensation utilization review processes and requirements • Ability to interpret and apply client-specific requirements, audit criteria, scoring methodologies, and quality standards • Strong working knowledge of evidence-based and jurisdiction-specific clinical guidelines and criteria, including ODG, MTUS, and other applicable state-specific treatment guidelines • Strong analytical skills, including trend identification, discrepancy investigation, and root-cause analysis • Ability to translate audit findings and data into practical process improvements and corrective actions • Experience providing quality feedback, coaching, or education to operational teams • Strong written and verbal communication skills • Strong attention to detail and ability to independently manage recurring audits, deadlines, documentation, and follow-up activities • Proficiency with Microsoft Office and reporting, audit, and case-management systems • Ability to collaborate across Operations, Quality, Technology, and other functional teams • Ability to travel up to 10% • 3+ years’ experience working with the client(s) the role will support in a QA function (preferred) • Ability to supply and support personal internet services for remote work • Uninterrupted internet connection required for work from home

🏖️ Benefits

• Medical, dental, and vision coverage for employees and families • Voluntary life insurance for employees, spouses, and children • Voluntary hospital indemnity, critical illness, accident indemnity, and pet insurance plans • Basic life insurance at no cost • Short-term disability coverage at no cost • Long-term disability coverage at no cost • Generous paid time off • 401(k) plan with company match • Apple equipment for remote workspace • Media stipend for remote workspace • Collaborative remote culture • Professional growth opportunities • Comprehensive benefits • Commitment to employee development