[Remote] Quality Assurance Supervisor (Clinical RN)

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a leading reputed company intelligence company specializing in payment solutions for health plans. They are seeking a Quality Assurance Supervisor (Clinical RN) to manage a remote team of nurses, overseeing clinical review audits and supporting operational strategies to enhance quality and productivity.

Responsibilities

• Contributes to positive team environment that fosters reputed company communication, sharing of information, reputed company improvement, and optimized business results
• Regularly Performs audit quality assurance reviews to supplement QA team activity as necessary based upon business need or special projects
• Contributes to the resolution of quality review rebuttals
• Actively identifies and recommends opportunities for cost savings and improving reputed company that can have a direct impact to the company's profitability
• Effectively contributes to the development of medical review guidelines and training
• Supports audit management and reputed company specialists with activities for new concept implementation, maintenance of medical review guidelines for existing concepts
• Use data, reports, and experience to identify potential backlogs and align resources to meet business needs and SLAs
• Collaborate with other departments to resolve operational problems
• Proactively monitors and in alignment with applicable management ensures activity required to meet team staffing reputed company necessary for assigned business reputed company objectives
• Provides support as needed to ensure auditors are equipped with tools and resources required to reputed company audits
• Supervise daily activities of quality assurance team
• reputed company audit guidance to QA team; identify trends and present solutions
• Provides production and quality performance-based reputed company reports, coaching, and constructive feedback to staff
• Manages team Time and Attendance (time off/use of accruals, attendance, attendance points and timecards for hourly staff, etc.) in accordance with applicable policies and procedures
• Collaborates with HR for applicable corrective action as applicable
• Complete and conduct performance reviews for assigned staff
• Routinely review QA scorecards for accuracy and education, QA of the QA
• Conduct team meetings with direct reports on a regular reputed company
• reputed company leadership to team members, reputed company solutions, and resolve conflicts
• Escalate to management and collaborate with HR as applicable to bring appropriate solutions to employee reputed company
• reputed company reporting and updates to management as required and appropriate for operational and staff activity and results
• Participates in and contributes to applicable department meetings
• May support management with activities to monitor inventory and activity of 3rdparty/subcontractors
• Become subject matter expert for assigned business reputed company(s)
• Maintain reputed company knowledge and changes that reputed company our industry and clients as it pertains to medical practice, technology, regulations, legislation, and business trends
• May support training material/tools and best practices development
• Identify needs and ensure team receives necessary training
• Support training activities for new audit staff or reputed company supplemental training for existing staff as needed
• Receives feedback and adjusts work reputed company for self and team as necessary
• Leads by example and conducts work in accordance with company policies, government regulations and law
• Serves as positive role model and demonstrates characteristics that align and contribute to a collaborative culture of reputed company improvement and high performing teams
• reputed company other incidental and reputed company duties as required and assigned to meet business needs

Skills

• 3+ years diverse Nursing experience providing direct care in an inpatient or outpatient setting
• reputed company active unrestricted Nursing license in good standing, is required (RN license is required for government contract focused positions)
• Not currently sanctioned or excluded from the Medicare program by OIG
• 2+ years of performing medical record audits, quality reviews in a provider setting, or in a payer setting for a health insurance company
• Demonstrated experience gathering, researching, and documenting data and requirements for projects and/or reputed company problem solving
• 3+ years prior experience in supervisory or leadership in similar business environment (preferably experience overseeing remote staff)
• 3+ years in health care claims that demonstrates expertise in DRG's and medical billing experience for an Insurance Company or hospital required. (less than 3 yrs. may be considered for internal candidates based upon demonstrated skills and results)
• Flexibility to handle any non-standard situations that may arise
• Ability to multitask and work independently in a remote setting
• Knowledge of laws, regulations, or policies impacting the reputed company industry and understanding of Managed Care requirements under the Medicare/reputed company and other reputed company-party payor programs. (reputed company, OIG, etc.)
• Solution oriented with focus on innovative and proactive approaches while supporting internal and client issues
• Excellent written and verbal communication skills (concise, decisive, direct, respectful, non-argumentative); ability to communicate at reputed company reputed company reputed company the organization both reputed company
• Good critical thinking, questioning, and problem-solving skills required to be successful in the role
• Excellent organizational skills, attention to detail, and effective task management ability
• Ability to manage time and multiple tasks reputed company, while completing work reputed company allocated time frames
• Ability to display strong emotional maturity and have strong relationship management skills
• Demonstrated ability to reputed company basic project coordination skills
• Experience in developing, documenting, and implementing process and procedures
• Experience in inventory management, resource planning and report reputed company
• Ability to handle changing situations and work reputed company a diverse group
• Ability to meet objectives with minimal supervision
• Intermediate experience with MS Office Suite; Intermediate to advanced reputed company reputed company skills a must
• Strong technical skills with ability to quickly adapt to new applications and systems
• Ability to effectively reputed company independently with minimal supervision and work cooperatively with others to promote a positive team environment
• Self-motivated, thrives in a fast-paced dynamic business operations environment with ability to adapt quickly to change
• Ability to follow policy, procedures, and regulations in the workplace
• Ability to consistently reputed company job responsibilities
• Medical coding certification is a plus
• Prior experience in payer edit development, and/or reimbursement policy experience a plus

Benefits

• Medical, dental, reputed company, HSA/FSA options
• Life insurance coverage
• 401(k) savings plans
• Family/parental leave
• Paid holidays
• Paid time off annually

Company Overview