Utilization Management, Clinical QA Supervisor

About the role

The Clinical QA Supervisor oversees the review of Physician reports and accompanying medical records to ensure completeness, accuracy, and consistency with medical evidence. They also oversee QA staff, supervise the File Review Board, and assist in hiring and managing staff performance.

Responsibilities

• Oversight of QA staff and assignment of responsibilities
• Supervision of assigned staff and management of the File Review Board
• Providing details of board reviews to managers
• Aiding in identifying and correcting staff performance issues
• Aiding in hiring qualified candidates for QA open positions
• Maintaining adherence to job duties by following up with Physicians, reviewing reports, delivering completed reports, and ensuring compliance with client-specific instructions
• Participating in issue resolution through collaboration with relevant parties
• Ensuring referrals meet the client-directed Turn Around Time (TAT)
• Acting as a liaison between reviewers, team members, and clients
• Performing other duties and special projects as assigned and based on business needs

Requirements

• An Associate's Degree or Bachelor's Degree is preferred.
• RN licensure is required.
• Medical peer review or healthcare industry knowledge is required.
• Business experience in a healthcare and/or insurance setting is preferred.

Skills & Competencies

• 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

Benefits

Join our team at Dane Street and enjoy a comprehensive benefits package including medical, dental, and vision coverage, life insurance, short-term and long-term disability, and a 401(k) plan with a company match. Additional benefits include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. We also provide an Apple device and a media stipend for remote work.

About Dane Street

A fast-paced, Inc. 500 Company, we process over 200,000 insurance claims annually for various clients. We provide customized Independent Medical Exams and Peer Review programs to assist our clients in reaching appropriate medical determinations as part of the claims management process.