Quality Analyst (Remote, LPN Required)

The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring that medical services are used efficiently and appropriately.

Requirements

• Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines, ensuring the medical necessity of treatments
• Examine and evaluate patient records to verify the quality of patient care and the necessity of provided services
• Offer clinical expertise and serve as a clinical reference for non-clinical staff members
• Input and manage essential clinical details within various medical management platforms
• Keep up-to-date with regulatory prerequisites (such as URAC) and state standards for utilization review
• Apply clinical reasoning to determine the suitable evidence-based guidelines
• Foster efficient and high-quality patient care by effectively communicating with management teams, physicians, and the Medical Director

Benefits

• health insurance
• retirement plans
• performance bonuses
• medical
• dental
• vision coverage
• voluntary life insurance options
• hospital indemnity
• critical illness
• accident indemnity
• pet insurance plans