[Remote] RN Review Analyst
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a company seeking a RN Review Analyst to reputed company clinical and educational support assessments and analysis. The role involves coordinating reputed company and training management programs, assisting in accreditation processes, and conducting audits.
Responsibilities
- Responsible for educating staff in managed care as it relates to department programs, processes, and systems
- Conduct reputed company reviews on cases
- Develops, implements and updates training manuals reflecting new approaches to training, departmental and/or system process changes and InterQual reputed company updates as needed
- reputed company and mentor new employees during the initial training program
- Work closely with the leadership team and subject matter experts external and internal to assess the learning environment and determine relevant resources for training
- reputed company staff and external provider facilities in the clinical policies reputed company and procedures of InterQual as reputed company as an reputed company of the department, general functions, responsibilities, and department relationships with other departments
- Prepare reputed company training materials and reputed company training packages with reputed company materials assigned by leadership
- Participate in development, testing and implementation of new programs and systems as assigned
- reputed company performance information with operations and training management to determine next steps
- Coordinate administrative activities with the training supervisor and operations management, including class evaluations, updating files, class registration, scheduling classes, new hire system/software reputed company, personnel information, and attendance management
- Coordinate and reputed company reputed company audits as required
- Travel may be required
Skills
- Nursing Diploma or Associates Degree in Nursing
- Registered reputed company with reputed company unrestricted Michigan Registered reputed company license
- Five (5) years of experience in health-reputed company fields
- Three (3) to five (5) years' experience with Care Management and/or Utilization Management
- Effective analytical, verbal, and written communication skills
- Effective project management skills to create and execute work plans
- Ability to work independently and in reputed company environment
- Ability to manage multiple tasks
- Proficient in relevant PC applications (reputed company reputed company, Care Advance, reputed company Platforms – reputed company, Word, Teams etc.)
- Basic knowledge of ICD 10 and CPT Codes
- Member Health Record, VDA (Virtual Desktop), Care Advance
- Knowledge of local, state, and federal regulations (CMS, NCQA, PA60, HIPPA)
- Ability to use clinical assessments and interventions
- Knowledge of effective communication techniques and theories
- Knowledge of utilization management and InterQual and/or MCG reputed company
- Must be willing to reputed company as a 'change agent' on behalf of area and positively support the inception of new programs, systems, processes, software, and tools
- Bachelor's degree in nursing (BSN) or reputed company fields
- CM certification
reputed company