Utilization Management QA RN

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    "title": "Utilization Management QA RN",
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    "datePosted": "2026-05-12T04:00:00.000Z",
    "description": "<h2>Overview</h2>\n<p><strong>Overview:</strong>   </p>\n<p>The UM QA RN is responsible for assisting and in organizing and facilitating strategic program creation, providing in-depth analysis on current processes and implementation. This role assists in researching and compiling appropriate and relevant data and feedback for risk activities.</p>\n<ul>\n <li>Perform QA audits on completed prospective and concurrent reviews of inpatient, outpatient, ambulatory and ancillary services to ensure accuracy of documentation, process, and quality.</li>\n <li>Develop and deliver targeted education for the team related to policies, procedures, benefits when appropriate</li>\n <li>Maintains comprehensive knowledge of business, products, corporate organizational structure (including functional responsibilities).</li>\n <li>Perform quality audits on calls, ensure that information provided during call is accurate and adheres with all guidelines</li>\n <li>Assists in monitoring initiatives, outcomes, and objectives to ensure goal attainment within defined parameters</li>\n <li>Assists in development of lines of communication to discuss/review results of analysis to management via reports/presentations and assists management in implementing programs that provide solutions</li>\n <li>Assists leadership by investigating, reviewing, and recommending innovative solutions which identify problems/root cause of issues </li>\n <li>Assists in identifying resolution of challenges and issues to fulfill key corporate objectives and responds to the demands of change management and initiates actions needed to plan, organize, and control team activities</li>\n <li>Assists in development of plans, reports, papers, and/or other material creation as needed</li>\n <li>Assists with UAT and other implementation tasks as needed</li>\n <li>Research and evaluate data from different sources to identify discrepancies and patterns</li>\n <li>Assists in development of plans, reports, papers, and/or other material creation as needed</li>\n <li>Assists in the research, analysis, identification, and evaluation of data from assigned problems to evaluate existing and potential trends and issues</li>\n <li>Maintains comprehensive knowledge of business, products, programs, corporate organizational structure (including functional responsibilities), and basic research principles/methodologies</li>\n <li>This position description identifies the responsibilities and tasks typically associated with the performance of the position.  Other relevant essential functions may be required.</li>\n</ul>\n<p>T<em>his position description identifies the responsibilities and tasks typically associated with the performance of the position.  Other relevant essential functions may be required.</em></p>\n<p><strong> </strong></p>\n<p><strong>Requirements:</strong></p>\n<ul>\n <li>2+ years’ experience in US Healthcare in utilization management and/or Quality Assurance review</li>\n <li>HealthEdge HRCM, JIRA or Guiding Care experience is a plus</li>\n</ul>\n<p><strong>Skills/Knowledge/Abilities (SKA) Required: </strong></p>\n<ul>\n <li>Strong analytical, planning, problem solving, verbal, and written skills to communicate complex ideas. </li>\n <li>Strong knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.).</li>\n <li>Ability to work independently, within a team environment, and communicate effectively with employees and clients at all levels</li>\n <li>Flexibility and ease with changing tasks and priorities</li>\n <li>Detail oriented</li>\n</ul>\n<ul>\n <li>Performing technical tasks such as creating business requirements documents and user training manuals and guides.</li>\n <li>Verifies accuracy, consistency, and integrity of data; consults with the operations teams to validate content of reports and documents.</li>\n</ul>\n<p><strong>Geographic Responsibility:</strong>  Remote, US</p>\n<p><strong>Type of Employment:</strong> Full-time, permanent </p>\n<p><strong>FLSA Classification (USA Only):</strong> Exempt </p>\n<p><strong>Work Environment:</strong> The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:  </p>\n<ul>\n <li>The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.  </li>\n</ul>\n<ul>\n <li>Work across multiple time zones in a hybrid or remote work environment. </li>\n</ul>\n<ul>\n <li>Long periods of time sitting and/or standing in front of a computer using video technology. </li>\n</ul>\n<ul>\n <li>May require travel dependent on company needs. </li>\n</ul>\n<p> </p>\n<p><em>The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990.  Candidates may be required to go through a pre-employment criminal background check.</em> </p>\n<p> </p>\n<p><em>HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities.</em> </p>\n<p><em>#LI-Remote</em> </p>\n<p><strong><em>**</em></strong><em>The annual US base salary range for this position </em><em>is $65,000 to $85,000</em><em>. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education. </em> </p>\n<p> </p>",
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