Clinical Quality Assurance Professional

4 days ago


Los Angeles, California, United States Axelon Services Corporation Full time
Role Description
Axelon Services Corporation is seeking a dedicated Nurse Coordinator to join our team. As a key member of our healthcare services team, you will be responsible for ensuring that our members receive high-quality, cost-effective care. Your tasks will include conducting utilization management activities, identifying potential quality issues, and supporting provider dispute resolution processes.

The estimated annual salary for this position is $90,000 - $115,000, depending on qualifications and experience. If you are a compassionate and detail-oriented individual with a passion for healthcare, we encourage you to apply.

About the Position
In this role, you will work closely with our healthcare providers to ensure that our members receive the best possible care. Your responsibilities will include:
• Conducting utilization management activities in accordance with health plan policies and regulatory guidelines
• Identifying and reporting Potential Quality Issues (PQI) and supporting Provider Dispute Resolution (PDR) processes
• Completing other duties as assigned by management

Key Requirements
To succeed in this role, you must have:
• A BSN or MSN degree
• Current valid California RN license
• Two or more years of experience in utilization management, preferably in Medicare Advantage or managed care
• Knowledge of Medicare Advantage regulatory guidelines, including CMS regulations
• Experience with Potential Quality Issues (PQI) identification and reporting
• Familiarity with Provider Dispute Resolution (PDR) processes
• Strong clinical assessment and critical thinking skills
• Proficiency in electronic health records (EHR) and utilization management software
• Excellent written and verbal communication skills

Our Culture
Axelon Services Corporation is committed to fostering a positive and inclusive work environment. As a valued member of our team, you will have access to ongoing training and development opportunities, competitive compensation and benefits, and a collaborative culture that values teamwork and innovation.

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