Dane Street is hiring a
Lead Clinical RN Quality Assurance

Summary

The job is for a Lead Clinical (RN) QA Specialist in Long Term Disability. The role involves reviewing reports, communicating with physician reviewers, and meeting deadlines. The candidate should have at least 5 years of claims experience, a required RN degree, and long-term disability experience.

Requirements

• An Associate’s Degree or Bachelor’s Degree is preferred
• RN required
• 5+ years of claims experience, preferred
• Long Term Disability experience required
• Business experience in a healthcare and/or insurance setting is preferred
• Must work with a sense of urgency and meet deadlines
• Must be self-motivated, with a strong drive for performance excellence
• Excellent written and verbal communication skills are required
• Proficiency in navigating a variety of computer programs (Experience with Google Chrome, Gmail, Docs, Sheets, etc. is a plus)
• Attention to detail REQUIRED

Responsibilities

• Assess the quality of physician reports, ensuring they meet all client and jurisdictional standards specific to long-term disability claims
• Verify that the claims support the physicians determinations in long-term disability claims
• Read and apply policy guidelines and healthcare terminology, determining when criteria for long-term disability are met
• Provide strong customer service by working closely with clients on a case-by-case basis to deliver complete, timely, and error-free quality assurance for long-term disability cases
• Manage and provide oversight for complex long-term disability cases requiring additional review prior to returning to the client
• Serve as an additional level of QA for cases with quality issues, utilizing clinical claims knowledge specific to long-term disability
• Participate in other duties and special projects, as assigned, based on business needs

Benefits

• Health insurance
• Retirement benefits
• Paid time off
• Remote work, flexible hours
• Life and disability insurance
• Bonuses and incentives
• Professional development opportunities
• Wellness programs
• Family and parental leave