Clinical Quality Specialist

23 hours ago


Chicago, Illinois, United States US Tech Solutions Full time
About the Role:

As a Clinical Quality Specialist at US Tech Solutions, you will play a vital role in ensuring the delivery of high-quality healthcare services. Your primary responsibility will be to participate in the development and implementation of Quality Management (QM) Work Plan activities, focusing on improving quality products and services through measurement and analysis.

In this dynamic position, you will review documentation, evaluate Potential Quality of Care issues based on clinical policies and benefit determinations. You will also consider all documented system information as well as additional records/data presented to develop a determination or recommendation.

The ideal candidate should have excellent analytical skills, with the ability to navigate multiple system applications, gather data, and interpret results. Additionally, strong communication and problem-solving skills are essential for collaborating with internal/external clinicians to resolve complex cases. As a part of our team, you will contribute to the development and implementation of QM projects and activities, ensuring compliance with business, regulatory, and accreditation requirements.

A successful Clinical Quality Specialist should possess 3+ years of experience as an RN, with prior authorization utilization experience. You should also have Medcompass or AssureCare experience and knowledge of managed care, Medicare, and Medicaid. Strong UM experience, particularly inpatient utilization management review, is highly desirable. We offer a competitive salary ranging from $85,000 to $110,000 per year, depending on your qualifications and location.

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