Clinical Nurse Manager, Field Care Delivery
ConcertoCare
Quality Assurance Specialist, Clinical RN – Disability
Dane Street
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $65,000 - $90,000 per year
Job Level
Mid-LevelSenior
About the role
- Review and ensure accuracy and completeness of reports accompanying medical records for long-term disability claims
- Assess the quality of physician reports, ensuring they meet all client and jurisdictional standards specific to long-term disability claims
- Verify that the claims support the physicians determinations in long-term disability claims
- Read and apply policy guidelines and healthcare terminology to determine when criteria for long-term disability are met
- Communicate with physician reviewers and their teams to ensure clarity of information and address posed questions
- Provide strong customer service by working closely with clients on a case-by-case basis to deliver complete, timely, and error-free quality assurance for long-term disability cases
- Manage and provide oversight for complex long-term disability cases requiring additional review prior to returning to the client
- Serve as an additional level of QA for cases with quality issues, utilizing clinical claims knowledge specific to long-term disability
- Participate in other duties and special projects, as assigned, based on business needs
- Meet client deadlines and maintain high standards of performance
Requirements
- RN required
- An Associate’s Degree or Bachelor’s Degree is preferred
- 5+ years of claims experience, preferred
- Disability experience required
- Business experience in a healthcare and/or insurance setting is preferred
- Must work with a sense of urgency and meet deadlines
- Must be self-motivated, with a strong drive for performance excellence
- Excellent written and verbal communication skills are required
- Proficiency in navigating a variety of computer programs (Experience with Google Chrome, Gmail, Docs, Sheets, etc. is a plus)
- Attention to detail REQUIRED
- Present exceptional communication skills with a clear understanding of company business lines
- Ability to apply critical thinking, manage time efficiently and meet specific deadlines
- Computer literacy and typing skills are essential
- Must supply and support own internet service and maintain an uninterrupted internet connection for work-from-home role
