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Clinical Quality Assurance Analyst

2 months ago

Antioch, Tennessee, United States Dane Street, LLC Full time
Job Overview

Position Summary:

About Dane Street: Dane Street is committed to enhancing employee wellness by cultivating a positive workplace that emphasizes client satisfaction and results. Our achievements depend on the daily contributions of both individuals and teams. We prioritize the well-being of our clients and each other.

Role Description: The Clinical Quality Assurance Analyst is crucial in the review process, tasked with liaising with clients, reviewers, and management to guarantee the timely submission of completed reports by the requested deadlines. In addition to fulfilling the responsibilities of a Quality Analyst, this role ensures the precision and sufficiency of clinical content and acts as a resource for non-medically trained Quality Analysts.

KEY RESPONSIBILITIES

Referral Management:

  • Oversee all referrals assigned to a reviewer within the specific division.
  • Examine assigned referrals daily to confirm completion or escalation of client-specific tasks as per established procedures.
  • Ensure adherence to company-specific best practices on all referrals daily, following the defined processes.
  • Guarantee the prompt delivery of the final report.

Communication:

  • Engage with reviewers, clients, and internal staff professionally through written and verbal communication, adhering to all established protocols and guidelines.

Clinical Responsibilities:

  • Conduct independent evaluations of a claimant's medical records ("Nurse Review") for clients upon request.
  • Act as an additional layer of quality assurance for cases with identified quality concerns.

Qualifications:

  • Medical background or relevant clinical experience is essential.
  • Meticulous attention to detail and accuracy in reviewing clinical content.
  • Exceptional verbal and written communication abilities.
  • Capability to collaborate effectively in a team-oriented setting.
  • Strong organizational and time management skills.

Why Choose Dane Street?

  • We appreciate individual and team contributions that propel our success.
  • We emphasize maintaining a supportive and positive work atmosphere.
  • We are dedicated to client satisfaction and delivering high-quality outcomes.

EDUCATION AND EXPERIENCE:

An Associate's Degree or Bachelor's Degree is preferred.

RELEVANT EXPERIENCE:

Experience in a healthcare and/or insurance environment is preferred.

SKILLS AND COMPETENCIES:

  • Active Registered Nurse license.
  • Experience in disability assessment is required.

WORKING CONDITIONS:

May involve lifting, bending, and other physical activities required to perform the job duties. Extended periods of sitting and computer usage are expected.

TECHNICAL REQUIREMENTS FOR REMOTE WORK:

Must provide and maintain their own internet services. An uninterrupted internet connection is a requirement for all remote positions.

COMPENSATION AND BENEFITS:

Dane Street is committed to offering fair and competitive compensation that reflects each employee's contributions and performance. We value diversity and strive to create an inclusive environment for all employees. Our comprehensive benefits package includes medical, dental, and vision coverage for employees and their families, along with voluntary life insurance options. Additional benefits include short-term and long-term disability coverage at no cost, a generous paid time off policy, and a 401k plan with company matching.

ABOUT DANE STREET:

Dane Street is a fast-paced, Inc. 500 Company with a high-performance culture, processing over 200,000 insurance claims annually for various clients, including national and regional Workers' Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide tailored Independent Medical Exams and Peer Review programs that assist our clients in achieving appropriate medical determinations as part of the claims management process.