USRN or PHRN Worker’s 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.

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.