Dane Street is hiring a remote Quality Analyst (LPN Required) to ensure medical services are used efficiently and appropriately. In this utilization management role, you will review medical records and treatment plans, collaborating with healthcare providers, insurance companies, and patients to optimize care delivery, control costs, and maintain quality.
What You'll Do
- Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines.
- 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 and state standards for utilization review.
- Apply clinical reasoning to determine suitable evidence-based guidelines.
- Foster efficient and high-quality patient care by effectively communicating with management teams, physicians, and the Medical Director.
- May provide oversight to the work of team members.
- Continuously improve processes to facilitate better turnaround time, peer-to-peer success rates, and lessen returned reports.
- Responsible for the final approval on cases for release to the client.
- Act as a liaison and coordinate quality issue reports along with all new reviewer reports with the VP of Clinical Operations.
What We're Looking For
- Licensed Practical/Vocational Nurse with an active and unrestricted license to practice.
- 2+ years minimum clinical nursing experience.
- 1+ year of previous experience in Utilization Management.
- Background in medical or clinical practice through education, training, or professional engagement.
- Proficient in both written and spoken communication.
- Capable of maintaining professional communication with physicians and clients.
- Skilled at handling multiple tasks and adjusting swiftly in a dynamic office setting.
- Possesses a keen organizational sense and pays close attention to details.
- Adept at resolving intricate and multifaceted problems.
- Demonstrate strong abilities in both spoken and written communication, along with effective interpersonal skills.
- Possess a proficient understanding of computer operations.
- Show the capability to acquire new skills and competencies to address evolving requirements.
- Supply and support your own internet services.
- Maintaining an uninterrupted internet connection is a requirement.
Technical Stack
- Microsoft Word, Excel, PowerPoint, Outlook, Access
- Windows
- Internet
Team & Environment
You may provide oversight to the work of team members and will report to the VP of Clinical Operations.
Benefits & Compensation
- Compensation range: $45,000 - $70,000 USD
- Health, dental, and vision insurance
- Voluntary life insurance options for employee, spouse, and children
- Voluntary hospital indemnity, critical illness, accident indemnity, and pet insurance plans
- Basic life insurance, short-term disability, and long-term disability coverage at no cost
- Generous paid time off policy
- 401k plan with a company match
- Apple equipment and a media stipend for remote workspace
Work Mode
This is a fully remote position.
Dane Street values diversity and strives to create an inclusive environment.
