Clinical Readmission Review Quality Analyst

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $60.1k - $98.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 2%

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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EXL

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

📦 Logistics

💰 $2M Venture Round on 2015-01

Healthcare • Insurance • Logistics

EXL is a business consulting and services firm that focuses on leveraging data to enhance business operations and decision-making. With a strong emphasis on collaboration and adaptability, EXL partners with organizations to address their unique needs and culture while integrating data science and technology solutions. The company's areas of expertise include operations management, decision analytics, digital transformation, and various industries such as healthcare, finance, and insurance. EXL's mission is to help clients drive business evolution and maintain competitive advantage through tailored solutions and effective use of data.

📋 Description

• Oversee work performed by Clinical Readmission Review Auditors • Perform quality reviews of random and targeted samples of completed readmission audits • Validate findings, no-findings, clinical rationale, and supporting documentation • Follow approved sampling methodology for random, targeted, and follow-up quality reviews • Apply quality scoring criteria to evaluate audit accuracy, documentation quality, and adherence to program expectations • Confirm readmission determinations are supported by medical records, clinical criteria, client requirements, and internal procedures • Review audit documentation for clarity, completeness, grammar, evidence-based support, and alignment with quality expectations • Provide feedback and coaching support to auditors • Identify audit trends, missed opportunities, recurring errors, and potential referrals for additional review or escalation • Perform root cause analysis and recommend corrective actions • Support calibration discussions, quality monitoring, procedure updates, and training opportunities • Document quality review outcomes, audit findings, supporting rationale, error trends, and recommended next steps • Maintain quality review results and reporting for performance monitoring, trend analysis, and leadership review • Communicate quality results, barriers, trends, and improvement recommendations to peers and management • Follow company compliance, information security, HIPAA, and regulatory policies

🎯 Requirements

• Registered Nurse, Associate’s or Bachelor’s degree required • Active, unrestricted RN license in the United States required • 5+ years of acute care nursing, utilization review, clinical auditing, readmission review, quality review, or related healthcare experience preferred • Prior readmission, potentially preventable readmission, quality control, secondary review, peer review, audit validation, or clinical audit quality monitoring experience preferred • Knowledge of potentially preventable readmission concepts, readmission drivers, discharge planning, transitions of care, and medical necessity preferred • Strong knowledge of inpatient medical record review, discharge planning, readmission drivers, medical necessity, transitions of care, and documentation requirements • Ability to synthesize complex inpatient medical record documentation and make objective, evidence-based quality determinations • Excellent written and verbal communication skills, analytical skills, attention to detail, and ability to provide professional feedback • Proficient in Excel, Word, Outlook, OneNote, and general computer applications • Ability to work independently in a remote environment and deliver results during EXL core business hours • Knowledge of Clinical Readmission Review, Quality Control Review, Audit Sampling, Medical Record Review, Clinical Judgment, Potentially Preventable Readmissions, Root Cause Analysis, Quality Feedback, Calibration, Trend Identification, Written Communication, and HIPAA Compliance

🏖️ Benefits

• 100% remote, U.S.-based work opportunity • Up to 10% annual travel • Benefits information provided at https://www.exlservice.com/us-careers-and-benefits