Healthcare Quality Mgmt Consultant

Job title: Healthcare Quality Mgmt Consultant in USA at Apidel Technologies

Company: Apidel Technologies

Job description: Remote - Across USA
(This position is open to candidates in any location. )Required Qualifications:
3+ years of clinical experience required
RN with current unrestricted state licensure required,
Compact license preferred or State LicensePreferred Qualifications:
Managed Care experienced preferred
Utilization Management or Case
Management experience
Critical thinking skillsThis position reports to the Potential Quality of Care (PQOC) reporting manager. Position responsibilities include triage and data entry of quality-of-care referrals. Primary role will be reviewing potential quality of care referrals in the MedHok and CATs grievance applications. Use clinical judgement to determine if there is a potential quality of care concern. Each referral is reviewed for potential quality of care components and acceptance status is communicated within the grievance application. All accepted referrals are entered into the PQOC database. Data entry includes information from various internal systems. Additional duties include monitoring and handling incoming faxes, emails, medical records, other correspondence, and inquiries.Ensures accurate and complete documentation of required information to meet risk management, regulatory, and accreditation requirements. The candidate must be proficient with Microsoft products, databases and with conducting 100% of work activities on the computer.This is an Individual contributor role that applies specialized knowledge and works under general supervision and may be supervised based on guidelines and direction provided.Duties
Processes and evaluates complex data and information sets -Converts the results of data analysis into meaningful business information and reaches conclusions about the data-Prepares and completes QM documents based on interpretation and application of business requirements-Documents QM activities to demonstrate compliance with business, regulatory, and accreditation requirements-Assists in the development and implementation of QM projects and activities-Accountable for completing and implementation of QM Work Plan ActivitiesExperience
3+ years work related experience in the healthcare industry. 5+ years clinical and/or managed care experience in the healthcare industry and quality management- HEDIS Experience preferredPosition Summary
Participates in the development and ongoing implementation of QM Work Plan activities. Improve quality products andservices, by using measurement and analysis to process, evaluate and make recommendations to meet QM objectivesEducation
Bachelor's degree, Nursing degree, or other comparable healthcare experience.What days & hours will the person work in this position List training hours, if different.
8 hours worked, Monday - Friday, between the hours of 8am to 5pm local timePreferred skills
Healthcare Quality Mgmt Consultant

Expected salary:

Location: USA

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