Healthcare Quality Specialist

4 days ago


Chicago, Illinois, United States US Tech Solutions Full time
Job Summary
In this role, you will be responsible for participating in the development and ongoing implementation of quality management work plan activities. You will improve quality products and services by using measurement and analysis to process, evaluate, and make recommendations to meet quality objectives.

As a Quality Management Professional, you will review documentation and evaluate potential quality of care issues based on clinical policies and benefit determinations. This includes considering all documented system information as well as any additional records/data presented to develop a determination or recommendation.

Data gathering requires navigation through multiple system applications. Staff may be required to contact the providers of record, vendors, or internal departments to obtain additional information.

The ideal candidate will have prior authorization utilization experience and managed care experience with knowledge of Medicare/Medicaid. A minimum of 6 months of prior authorization experience is required. Salary: $65,000 - $85,000 per year.

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