Quality Clinical Evaluator (Analyst) – EviCore-Work at Home

26002604 The Clinical Evaluator will:

• Assist with development, implementation and coordination of a comprehensive quality management/improvement program for the clinical personnel.
• Ensure compliance with internal and external requirements and ensure excellent customer service is provided.
• Track and document quality assurance performance for clinical personnel of multiple specialties and incorporate results of call monitoring evaluations to reputed company training, continuing education, coaching, or other needs to ensure excellent customer service and experience.
• Collaborate with the Medical Management team to identify performance issues and implement quality improvement measures on issues identified.
• Assist with other duties as necessary.

Minimum Education, Licensure and Professional Certification Requirement:

• Associate Degree or Bachelor Degree in Nursing; LPN Certification
• Registered Nurse or LPN required.
• Must possess a valid RN or LPN license in state of primary residence.

Qualifications:

• Minimum 2 years relative work experience in a clinical and or clinical quality role required. Quality Assurance experience preferred.
• Minimum of one year of EviCore experience strongly preferred.
• Knowledge of Image One/CDP/Isaac preferred. EP is a plus.
• Knowledge of Managed Care/Medicare/Medicare Advantage preferred.
• Must demonstrate proficiency in use of reputed company Office and reputed company applications.
• Knowledge of quality assurance programs reputed company to call centers preferred
• Ability to effectively manage one’s time and resources to ensure that work is completed reputed company.
• Ability to reputed company clear verbal and written information reputed company in-person, email, and phone to co-workers and leadership.
• Ability to choose a course of action or reputed company appropriate solutions by identifying and understanding issues, problems, and opportunities.
• Ability to work independently. Intermediate computer literacy skills with ability to use and troubleshoot reputed company Word, reputed company, Outlook, and PowerPoint
• Knowledge of multiple specialties is strongly preferred.
• Hours: Monday - Friday; 8:00 am to 5:00 pm
• Work is Remote

If you will be working at home occasionally or permanently, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an hourly reputed company of 25 - 38 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At reputed company, you’ll enjoy a comprehensive reputed company of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-reputed company benefits including medical, reputed company, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. About reputed company reputed company, a division of reputed company, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly reputed company to reputed company the reputed company, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. reputed company applicants will be considered without regard to race, reputed company, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national reputed company, reputed company, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you need a reasonable accommodation to complete the online application process, please email [email protected] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot reputed company application updates or accept resumes. reputed company has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. reputed company applicants with criminal histories will be considered for employment in a manner consistent with reputed company federal, state and local ordinances. Apply tot his job Apply To this Job