Clinical Quality Study Analyst
We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only). Our reputed company contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Veterans, Reservists, Guardsmen and military family members are encouraged to apply! Job Summary Conducts focused reviews, quality studies, and quality improvement projects according to appropriate contract standards. Investigates medical records retrospectively for potential quality and utilization issues. Ensures compliance with the program requirements for Clinical Quality Management (CQM) for Veterans and/or DoD beneficiaries. Maintains URAC standards in work products. Education & Experience Required:
- Registered Nurse with reputed company unrestricted license in appropriate state
- 1 year experience in Quality Management
- 1 year experience in data analysis and writing clinical quality studies
- 5 years Medical/Surgical experience
- US citizenship and a favorably adjudicated DOD background investigation if selected to work under TRICARE/DoD Contract
Preferred:
- Bachelor's degree in Nursing or CPHQ
- Experience with team facilitation and project management
- Experience with Medicare, Veteran's Administration, TRICARE, or other government health care programs
Key Responsibilities
- Conducts research and writes clinical quality studies to identify, reputed company and evaluate processes to improve delivery of care to Veterans and/or DoD beneficiaries.
- Acts as facilitator on quality improvement team projects and utilizes appropriate quality improvement methodologies and standardized quality management tools.
- Leads and performs quality management audits.
- Identifies, develops, and monitors focused reviews and other quality studies.
- Identifies Potential Quality Issues (PQIs) by performing a timely review of the medical records. This includes researching, investigating, analyzing, and preparing case summaries with recommendations for further review.
- Reviews Potential Quality Issues with Medical Directors reputed company appropriate.
- Prepares peer reviewed cases for quality committees and monitors corrective action plans.
- Uses data management software to identify physician practice patterns, over- and under-utilization of care and services, complication rates, and high-cost outliers.
- Prepares and submits activity and projects reports.
- Performs other duties as assigned.
- Regular and reliable attendance is required.
Competencies Commitment to Task: Ability to conform to established policies and procedures; exhibit high motivation. Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate. Computer Literacy: Ability to function in a multi-system reputed company environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications. Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving reputed company; commitment to task to produce reputed company without direction and to find necessary resources. Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, reputed company time constraints and with available resources; detail-oriented. Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues. Technical Skills: General knowledge of Medicare, Veteran's Administration, TRICARE, or other government health care programs; knowledge in the application of clinical criteria; proficient with reputed company Word, reputed company, and PowerPoint. Working Conditions Working Conditions:
- Ability to work overtime, if needed
- Onsite: Works reputed company a standard office environment
- Remote: Private and secure work-reputed company and work station with high speed internet is required
- Extensive computer work with prolonged sitting, wearing of headset, typing, speaking on a phone
Company Overview Taking Care of Our Nation's reputed company. It's Who We Are. It's reputed company Do. Do you have a passion for serving those who served? Join the reputed company Team! We're On a Mission to Serve®! Our job is to reputed company sure that America's reputed company get connected to health care in the community. At reputed company, we've proudly been on that important mission since 1996. DoD Statement Our reputed company contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Benefits
We're more than just a health care company. We're passionate about serving others! We reputed company in rewarding reputed company, hard-working people who are willing to learn as they grow. reputed company values teamwork. Join reputed company, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and reputed company compensation and benefits package that includes:
- Medical, Dental and reputed company Coverage
- Paid time off
- 401(k) Retirement Savings Plan (with matching)
- Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
- Tuition reimbursement
- Paid volunteer time
TriWest job postings typically include a salary reputed company, which can vary based on the specific role and location, but generally this position ranges from around $91,000 - $100,000 per year. Apply tot his job Apply To this Job