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Quality assurance specialist Jobs in Taylorsville ut

Last updated: 1 day ago
  • Promoted
Quality Assurance Nurse

Quality Assurance Nurse

AmTrust Financial Services, Inc.Salt Lake City, UT, United States
Show moreLast updated: 24 days ago
Quality Assurance Coordinator

Quality Assurance Coordinator

Nicholas and CompanySalt Lake City, UT
$23.00–$25.00 hourly
Show moreLast updated: 1 day ago
  • Promoted
Sales Quality Assurance Specialist

Sales Quality Assurance Specialist

VirtualVocationsSalt Lake City, Utah, United States
Full-time
Show moreLast updated: 1 day ago
Quality Assurance API Engineer

Quality Assurance API Engineer

Celtic BankSalt Lake City, UT, US
Full-time
Quick Apply
Show moreLast updated: 7 days ago
Quality Assurance Engineer

Quality Assurance Engineer

Smartcop, Inc.Utah, United States
Remote
Full-time
Show moreLast updated: 30+ days ago
  • Promoted
Quality Assurance Engineer

Quality Assurance Engineer

HID Global CorporationSalt Lake City, UT, United States
Show moreLast updated: 19 days ago
  • Promoted
Electrical Quality Assurance Representative

Electrical Quality Assurance Representative

WSPSalt Lake City, UT
Full-time
Show moreLast updated: 2 days ago
Quality Assurance Specialist

Quality Assurance Specialist

CPS, Inc.Salt Lake City, UT, US
Permanent
Show moreLast updated: 30+ days ago
  • Promoted
Quality Assurance Manager

Quality Assurance Manager

BBSISalt Lake City, UT
$85,000.00–$115,000.00 yearly
Full-time
Show moreLast updated: 9 days ago
  • Promoted
Quality Assurance Technician

Quality Assurance Technician

MZ Packaging, LLC.Salt Lake City, UT, US
Full-time
Show moreLast updated: 8 days ago
Quality Assurance

Quality Assurance

JobsRUs.comSalt Lake City, UT, United States
$23.50 hourly
Temporary
Show moreLast updated: 20 days ago
Quality Assurance Analyst

Quality Assurance Analyst

Education at WorkSalt Lake City, UT
$17.00–$21.00 hourly
Show moreLast updated: 28 days ago
Specialist, Quality Assurance

Specialist, Quality Assurance

PacksizeSalt Lake City, UT
$46,000.00–$52,000.00 yearly
Full-time
Show moreLast updated: 3 days ago
  • Promoted
Quality Assurance Technician

Quality Assurance Technician

MRINetwork JobsSalt Lake City, UT, US
Full-time
Show moreLast updated: 30+ days ago
Quality Assurance Inspector

Quality Assurance Inspector

Overhead Door CorporationSalt Lake City, UT, United States
Full-time
Show moreLast updated: 30+ days ago
Benefits Specialist

Benefits Specialist

TEKsystemsSalt Lake City,UT,84101,USA
Show moreLast updated: 30+ days ago
  • Promoted
Quality Assurance Technician

Quality Assurance Technician

HRmangoWest Valley City, UT, United States
Full-time
Show moreLast updated: 6 days ago
  • Promoted
Quality Assurance Manager

Quality Assurance Manager

Praxt Talent LLCSalt Lake, Utah, USA
Full-time
Show moreLast updated: 6 days ago
  • Promoted
Quality Assurance Nurse

Quality Assurance Nurse

AmTrust FinancialSalt Lake City, UT, United States
Show moreLast updated: 30+ days ago
Quality Assurance Nurse

Quality Assurance Nurse

AmTrust Financial Services, Inc.Salt Lake City, UT, United States
24 days ago
Job description

OverviewSeeking a dynamic, innovative, collaborative professional who embraces commitment to superior service and quality. AmTrust Financial Services, an industry-leading insurance provider and top writer of workers' compensation insurance, has a need for a Quality Assurance Specialist in medical case management oversight for workers' compensation within in our Managed Care Organization. The position is a remote position and can be located anywhere in the United States.PRIMARY PURPOSE : The Quality Assurance Specialist will provide comprehensive and quality oversight activities in line with the organization's quality and medical case management standards. This position will report to the Director of Medical Education and Strategy within the Managed Care Organization. Focus for role with development and execution of the Quality Assurance Programs for both internal and external managed care clinical programs to align with AmTrust's philosophy for holistic, injured employee centric approach to achieve best in class outcomes for claims. These responsibilities may include review of utilization review programs, pharmacy program clinical oversight, home health and all care coordination for claims in addition to identification and analysis of trends to provide recommendations for the overall program to further enhance and improve.Responsibilities

  • Carry out quality assurance oversight activities defined in the AmTrust Medical Case Management and Quality Assurance Standards.
  • Conduct regular and systematic review of Managed Care internal and external medical case management files with focus towards validation of comprehensive case assessments, evaluations and proactive strategies developed and executed to address medical and disability management, treatment and pharmacological plans to ensure evidence-based medicine is evaluated consistently.
  • Conduct regular and systematic review of Managed Care programs both internal and external including but not limited to utilization review, pharmacy, home health services, diagnostic, physical medicine and independent medical evaluations.
  • Reviews to also focus towards completion of activities and case management goals are in a timely manner, have appropriate follow ups, appointments are made within recommended frequency, ensure there are no gaps in service and medical care coordination.
  • Analysis of Quality Assurance reporting metrics to identify strengths, trending and provide recommendations which can support and tie into educational training development needs for the overall programs.
  • Measure and identify staffing competency levels from quality assurance reviews.
  • Track, monitor, and measure quarterly and annual performance of the programs.
  • Present reports, findings, and recommendations for enhancements and / or changes based on analysis to the Managed Care Leadership and Workers' Compensation leadership teams on both internal and external case management programs.
  • Work with managed care leadership and nurses to calibrate quality standards across all offices.
  • Review and conduct evaluation of external managed care clinical programs to ensure service level agreements, and performance measures are met and / or exceeded.
  • Conduct billing and financial audits for external strategic partners to ensure compliance with contracted financial agreements.
  • Act as liaison with external and internal strategic partners to manage overall quality measures of the case management program.
  • Other duties may be assigned.QualificationsEducation and Licensing
  • Active unrestricted RN license in a state or territory of the United States is required.
  • Bachelor's degree in nursing (BSN) from an accredited college or university or equivalent work experience or equivalent work experience preferred.
  • Certification in case management, rehabilitation nursing or a related specialty is required (CCM, COHN, CRRN, etc.).
  • Quality Assurance program designations such as Health Care Quality and Management certification (HCQM) highly preferred.
  • Acquisition and maintenance of insurance license(s) may be required to comply with state requirements.Experience
  • Minimum five (5) years of related experience required to include two (2) years of direct clinical care, and two (2) years of case management and minimum of one (1) year in quality assurance role is required. Prior analytical experience with data and reporting outcomes in managed care setting is required. Understanding and prior experience with URAC accreditation and utilization review programs is required.
  • Preferred previous clinical experience emergency room, critical care, home care or rehabilitation experience.
  • Skills and Knowledge Requirements :
  • Knowledge of workers' compensation laws and regulations
  • Knowledge of case management practice
  • Knowledge of the nature and extent of injuries, periods of disability, and treatment needed
  • Knowledge of URAC standards, ODG, Utilization review, state workers compensation guidelines
  • Knowledge of pharmaceuticals to treat pain, pain management process, drug rehabilitation
  • Knowledge of behavioral health
  • Excellent oral and written communication, including presentation skills
  • PC literate, including Microsoft Office products
  • Leadership / management / motivational skills
  • Analytic and interpretive skills
  • Strong organizational skills
  • Excellent interpersonal and negotiation skills
  • Ability to work in a team environment
  • Ability to meet or exceed Performance CompetenciesWork EnvironmentWhen applicable and appropriate, consideration will be given to reasonable accommodations.Position schedule is normal business hours Monday through FridayRequired travel : 10-15% - Travel is required for training, onboarding and as the business needs dictate.Mental : Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical : Computer keyboarding Auditory / Visual : Hearing, vision and talking#LI-GH1#LI-HYBRIDWhat We OfferWhat We OfferAmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include : Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.