Dane Street is looking for a remote Quality Analyst (LPN/RN Required) to join our team. In this Utilization Management Nurse Reviewer role, you will be crucial in ensuring medical services are used efficiently and appropriately by reviewing records, treatment plans, and patient information. You'll be part of a fast-paced, high-performance culture at an Inc. 500 company.
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 communicating effectively 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.
- Be responsible for the final approval on cases for release to the client.
- Act as a liaison and coordinate quality issue reports and all new reviewer reports with the VP of Clinical Operations.
What We're Looking For
- An unrestricted LVN/RN license from an accredited program; Licensed Practical/Vocational Nurse with an active and unrestricted license to practice.
- A minimum of 2 years of clinical nursing experience.
- At least one year of previous experience in Utilization Management.
- Proficient in both written and spoken communication, capable of maintaining professional dialogue with physicians and clients.
- Skilled at handling multiple tasks and adjusting swiftly in a dynamic environment.
- Possesses keen organizational sense and pays close attention to details.
- Adept at resolving intricate and multifaceted problems.
- Experienced with Microsoft tools such as Word, Excel, PowerPoint, Outlook, and Access.
- Background in medical or clinical practice through education, training, or professional engagement.
- Proficient understanding of computer operations, particularly the Internet and Windows.
- Capability to acquire new skills to address evolving requirements of systems, software, and hardware.
- Ability to supply and support your own internet services and maintain an uninterrupted connection.
Technical Stack
- Microsoft Word, Excel, PowerPoint, Outlook, Access
- Internet, Windows
- Various medical management platforms
Team & Environment
You may provide oversight to team members and will act as a liaison, coordinating quality and new reviewer reports directly with the VP of Clinical Operations.
Benefits & Compensation
- Compensation: $45,000 - $70,000 USD
- Medical, dental, and vision coverage for you and your family.
- Voluntary life insurance options for you, your spouse, and your children.
- Other voluntary benefits including hospital indemnity, critical illness, accident indemnity, and pet insurance plans.
- Employees receive 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 are provided for your remote workspace.
Work Mode
This is a fully remote position open to candidates located within the United States.
We are committed to providing fair and competitive compensation that reflects each employee's contributions and performance. We value diversity and strive to create an inclusive environment for all employees.
