York Risk Services Quality Assurance Nurse in Dallas, Texas

Job Description

JOB SUMMARY:

This position can be located in any state in the United States and licensed in any state.

The Q/A nurse will be responsible for performing quality review on outgoing determinations to ensure all state regulations and URAC requirements have been meet. He or she will communicate to the supervisors of any trends or patterns of specific staff that need attention.

On a daily basis the Q/A nurse will perform quality assurance on randomly selected staff case reviews to determine medical criteria and/or established policies and procedures have been met. He or she exercises flexibility and adaptability, utilizing time constructively, prioritizing and organizing assignments for maximum productivity.

ESSENTIAL JOB RESPONSIBILITIES:

  • Review and evaluate case decisions applying quality assurance criteria, state regulations, and URAC requirements;
  • Ensure accuracy and completeness of documentation;
  • Communicate effectively any inconsistencies and/or inaccuracies;
  • Compile and summarize data for presentation;
  • Assist in the development and implementation of appropriate action plans to approve and assure compliance with regulatory requirements;
  • Participate and understand scope of responsibility in all ongoing QA Projects;
  • Adheres to quality assurance standards; and
  • Maintains objectivity and confidentiality.

SUPERVISORY RESPONSIBILITIES:

SUPERVISION RECEIVED:

  • The Q/A nurse reports to the Compliance Manager.

SUPERVISION EXERCISED:

  • N/A Required Skills

SKILLS/ABILITIES:

  • Excellent grammar skills, critical thinking skills, and ability to manage time efficiently and meet stringent time frames.
  • Must be proficient in PC skills. (MS Word, Excel, and Outlook.)

KNOWLEDGE:

  • Must be knowledgeable of current URAC and multi-state regulations related to Workers' Compensation.
  • Must be knowledgeable of quality assessment and assurance procedures.
  • Must possess knowledge of medical terminology, medical records, and ICD 10.

Required Experience

EDUCATION:

  • Must have an RN license and CCM or CRRN.

EXPERIENCE:

  • 2 years clinical experience.
  • Workers' Compensation experience recommended

Tracking Code: DALLAS05101701

Job Location: Dallas, Texas, United States

Position Type: Full-Time/Regular