A non-profit healthcare company is searching for a person to fill their position for a Remote Home Health Quality Assurance Reviewer. Must be able to: Coordinate, monitor, and audit documentation and coding of home health and hospice. Analyze audit results.
Interpret criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Skills and Requirements Include: Active RN license without restrictions. Previous experience in utilization management.
Qualifications Include: 2 years of experience working in a customer serviceand / or compliant handling. Ability to manage multiple caseload daily. 2 years of experience working in healthcare. Bachelor's degree (or higher) or equivalent work.
Prior clinical experience in an acute care, skilled or rehabilitation clinical setting. Experience with quality improvement processes pertaining to Medicare guidelines. Excellent computer skills and ability to easily navigate multiple applications.
Evaluating care center operational processes in response to unfavorable internal or external audits. Skills and Requirements Include: Moderate travel. Current, unencumbered license to practice as a Registered Nurse in state of residence.
Minimum 1 year healthcare/health plan experience. Minimum 1 year HEDIS experience and/or knowledge. Solid knowledge of managed care requirements related to clinical quality. Research and detail oriented, excellent proof reading skills. Reliable internet connection (virtual)