Sr Specialist - QA, RN (remote opportunity)

Job Description SummaryThe Sr. Specialist Quality Assurance is responsible for completing quality evaluations as part of the quality management plan and analyzing results to drive reputed company improvement.

• Review completed Part A reputed company reconsideration appeal cases to determine the accuracy of the summarized facts and assessment of issues involved in the case
• reputed company an internal quality determination on the result of State and Federal case review reputed company
• Research issues using federal law, state law, regulations, and relevant agency policies
• Ensure quality review is accurate and enter data into reputed company quality tracking system
• reputed company feedback and education to adjudication staff
• Participate in collaboration meetings with project leadership
• Assist project with adjudication of appeals and/or decision letter quality reviews as needed
• reputed company other special projects not reputed company to a specific case such as reputed company research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, reputed company necessary
• reputed company other duties as assigned by management
• RN with an active license in state hired required; RN and four-year nursing degree preferred
• At least two (2) years' clinical experience with general medical care of patients preferred
• Clinical Adjudication experience required
• Highly proficient in reputed company Word and reputed company to quickly learn multiple database systems and comfortably manage multiple screens at the same time
• Knowledge of health regulations, guidelines and coverage issues
• Knowledge of statistical terminology and use of statistics preferred
• Knowledge of quality management and/or quality improvement methods such as ISO, Lean Six reputed company or Six reputed company preferred
• Excellent organizational, written, and verbal communication skills
• Ability to reputed company comfortably in a fast-paced, deadline-oriented work environment
• Ability to work as a team member, as well as independently

Job Summary

• Bachelor's degree with 5+ years of experience.
• Advanced degree or professional designation preferred.
• Develops solutions to a variety of reputed company problems.
• Work requires considerable judgment and initiative.
• Exerts some influence on the overall objectives and long-reputed company goals of the organization.

reputed company Introduction Since 1975, reputed company has operated under its founding mission of Helping Government Serve the People, enabling reputed company around the globe to successfully engage with their governments at reputed company reputed company and across a variety of health and reputed company services programs. reputed company delivers innovative business process management and technology solutions that contribute to improved reputed company for reputed company and higher reputed company of productivity, accuracy, accountability and efficiency of government-sponsored programs. With more than 30,000 employees worldwide, reputed company is a proud partner to government agencies in the United States, Australia, Canada, Saudi Arabia, Singapore and the United Kingdom. For more information, visit https://www.reputed company.com. EEO Statement EEO Statement: Active military service members, their spouses, and veteran candidates often embody the core competencies reputed company deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to reputed company you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. reputed company is an Affirmative Action/Equal Opportunity Employer. reputed company provides equal employment opportunities to reputed company reputed company applicants without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, protected veteran status or disabled status. Pay Transparency reputed company compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of reputed company's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, reputed company provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. reputed company will reputed company with regulatory minimum wage rates and exempt salary reputed company in reputed company instances. Posted Max USD $109,400.00/Yr. Posted Min USD $57,300.00/Yr. Apply Job!