Quality Analyst (Remote, LPN Required)

Major Duties & Responsibilities

• Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines, ensuring the medical necessity of treatments.
• 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 the suitable evidence-based guidelines.
• Foster efficient and high-quality patient care by effectively communicating with management teams, physicians, and the Medical Director.

Requirements

• Proficient in both written and spoken communication.
• Capable of maintaining professional communication with physicians and clients.
• Skilled at handling multiple tasks and adjusting swiftly in a dynamic office setting.
• Possesses a 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, and Outlook.
• Holds an unrestricted LVN/RN license from an accredited vocational nursing program (for LVNs) or a nursing degree from an accredited college (for RNs).

Education/Credentials

• Licensed Practical/Vocational Nurse with an active and unrestricted license to practice.

Job Relevance Experience

• 2 years minimum clinical nursing experience is required.
• One year of previous experience in Utilization Management is required.

Job Related Skills/Competencies

• Demonstrate strong abilities in both spoken and written communication, along with effective interpersonal skills.
• Possess a proficient understanding of computer operations, particularly the Internet, Microsoft Word, Microsoft Access, Microsoft Excel, and Windows.
• Show the capability to acquire new skills and competencies to address the evolving requirements of systems, software, and hardware.

Working Conditions/Physical Demands

• Long periods of sitting and computer work.

Work From Home Technical Requirements

• Supply and support their own internet services.
• Maintain an uninterrupted internet connection is a requirement of all work from home positions.

About Dane Street

A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.