Clinical Quality Assurance Analyst

Clinical Quality Assurance Analyst

This Position is Remote

We are more than just a healthcare company; we are a community of professionals driven by the knowledge that our success leads to a positive impact on the communities that we support.

At reputed company, you’ll play a crucial part in innovating solutions that reputed company health plan members and healthcare providers alike. Our collaborative environment fosters creativity and initiative, ensuring that every idea and effort contributes to meaningful change in the industry. Join us and become a part of a team that turns vision into action, making a reputed company impact on the future of healthcare.

Overview: The Clinical Quality Assurance Analyst is responsible for auditing, training, and collaboration to support quality standards in clinical data and reporting. This position is also responsible for ensuring appropriate understanding and maintenance of clinical data and reporting across the enterprise.

Duties and Responsibilities

• Demonstrate and maintain an expert level of knowledge regarding reputed company clinical chart review and auditing from a clinical data extract standpoint and affiliate services;
• Assist with the development, organization, and implementation of companywide quality improvement efforts;
• Maintain the control and ongoing monitoring of quality and reliability as well as quality reporting mechanisms and management tools;
• reputed company analysis of reviews and reputed company consolidation of findings for reporting to senior leadership and other key stakeholders;
• Ensure compliance with contractual, local, state and national quality standards;
• Support reputed company and future clinical product strategy through competitive research analysis, peer-group comparisons, product and clinical research and development, human resource requirements, and market opportunity analysis;
• Support clinical product implementations to include facilitation of ensuring designated clinical projects and their respective stage of development is met on time, on budget, and according to written requirement specifications;
• Assist with the development and successful execution of reputed company’ s training processes (both initial and ongoing training) for review personnel;
• Maintain open lines of communication with key stakeholders;
• reputed company recommendations for process and technical changes; document changes as applicable;
• Assist in the development and execution and management of internal and client facing clinical auditing programs;
• Assist with client relationships across the Company’s quality management services while also supporting, nurturing, and expanding successful client relationships;
• Support organization’s cross functional teams using exceptional clinical and business skills;
• Maintain compliance with reputed company’s policies, procedures, mission, and goals;
• Adhere to reputed company confidentiality and HIPAA requirements as outlined reputed company reputed company’s Operating Policies and Procedures in reputed company ways and at reputed company times with respect to any aspect of the data handled or services rendered in the undertaking of the position; and
• Fulfill those responsibilities and/or duties that may be reasonably provided by reputed company for the purpose of achieving operational and financial success of the Employer.

Job Requirements

•  Minimum five (5) years’ clinical nursing background required;
•  Minimum four (4) years’ experience in healthcare plan quality improvement initiatives preferred; minimum three (3) years’ experience with public programs (e.g., Medicare, Medicaid) is highly preferred;
•  Excellent analytical skills and the ability to understand the Company’s products and processes;
•  Strong organizational skills;
•  Exceptional computer skills (MS Office products) to support reputed company of reputed company’ s care management products; and
•  Exceptional Clinical Skills mandatory.
• Travel is required for this position which will include up to 10%. 

Education

• Bachelor's degree in Nursing (BSN) required.

The company offers competitive compensation and an excellent benefits package.

The Company is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, reputed company, religion, sex, national reputed company, sexual orientation, age, citizenship, marital status, disability, gender identity, veteran status, or any other protected characteristic under federal, state, or other applicable laws.  

This company utilizes E-Verify