USRN or PHRN Workers Compensation

POSITION SUMMARY:
As a Quality Assurance Specialist, you will assist the Directors of Case Management and case managers with their work by completing a variety of daily tasks. These tasks include, but are not limited to, reviewing case management reports, completing quality assurance scorecards, answering questions about customer programs, and educating the case managers on quality requirements as needed.

ESSENTIAL FUNCTIONS:
· Assist in assigning referrals to the appropriate team members.
· Assist the Director of Case Management with various tasks as needed.
· Assist with case management support tasks in the system.
· Answer case managers’ questions about customer programs in a timely manner.
· Communicate with others. Both written and verbal communication skills are widely utilized as a Quality Assurance Specialist.
· Complete quality audits on case management files.
· Educate case managers on quality requirements as needed.
· Manage diary dates to ensure timeliness of reports and other case related activities.
· Provide exceptional service to all internal customers.
· Responsible for completing Quality scorecards.
· Review case management reports and work for quality purposes.
· Review files for billing accuracy against account guidelines.

ESSENTIAL QUALIFICATIONS:
· Qualified and Experienced (required experience, education, certifications, licensure, and/or registrations):
o A valid RN licensure with an associated college degree is required.
o Must comply with licensure and/or certification requirements within the state(s) in which you practice is required.
o Must maintain all licensure and/or certification requirements within the state(s) in which you practice is required.
o Experience as a Registered Nurse is required.
o Experience as a Registered Nurse with workers’ compensation quality assurance experience is strongly preferred.
o You have the ability to travel using a valid driver’s license, reliable transportation and auto insurance.

· Motivated. You love to beat your own records, expect the best from yourself, and always want to keep improving. You are motivated by meeting and exceeding company and self-identified goals and expectations.
· Organized. You will be working in a fast-paced environment, in multiple systems, and providing responsive customer service and support to a wide variety of parties. You can keep pace in this type of environment.
· Collaborative. You must possess the required level of skills and abilities to read, write, speak and apply mathematical concepts and sound reasoning to successfully perform the essential functions of this job. This position requires problem-solving skills, critical thinking skills, and the ability to multi-task.
· Committed. You are committed to the daily application of our core values to deliver access to high quality care. You will comply with safety principles, Federal and State laws, regulations and standards.

You must be able to work Monday – Friday (graveyard shift). To perform this job successfully, you must be able to perform each essential function satisfactorily. The requirements listed above are representative of the knowledge, skills, and/or abilities required to perform these essential functions. Please note: reasonable accommodations may be made to eligible individuals with disabilities to perform the essential functions, so long as the accommodations do not cause undue hardship to the employer.