Healthcare Quality Mgmt Consultant - US Tech Solutions, Inc.
Please note: Actual location may vary., RI 02895
About the Job
Job Description:
- Responsible for the review and evaluation of clinical information and documentation. Reviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues. Independently coordinates the clinical resolution with internal/external clinician support as required.
- Reviews documentation and evaluates potential quality of care issues based on clinical policies and benefit determinations. Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation. Data gathering requires navigation through multiple system applications.
- 10 years of clinical experience required- Managed Care experience preferred
- Utilization Management
- RN with current unrestricted state licensure
Source : US Tech Solutions, Inc.