Clinical Quality Assurance Analyst (RN)

  • 16945 Northchase Dr, Houston, TX 77060, USA
  • Employees can work remotely
  • Full-time

Company Description

HealthHelp - A WNS Company (www.HealthHelp.com), is the leader in the field of healthcare utilization & care management. We have gained this position by actively working to change out-of-date practices with a collaborative, non-denial based approach. Our methodology helps payors achieve a higher return on investment, gives providers education programs that better inform physicians, and ensures quality and safety for the patients needing treatment.

HealthHelp’s innovative approach and strong IT capability in specialty benefits management means that staff will move healthcare forward when provided with evidence-based solutions and second opinions. HealthHelp's staff is comprised of healthcare professionals who make a difference every day. HealthHelp has a desire to fill their company with talented and innovative people who want a career path filled with success and personal growth.

Our specialty benefits management services are broad and include, Cardiology, Oncology, Radiology, Radiation Therapy, Sleep Care, and Musculoskeletal Care. HealthHelp has two locations in Houston, one a corporate office and the second a state-of-the art contact center. HealthHelp is also proud to have another such contact center in Albany, New York.

WNS Global Services Inc. (NYSE: WNS) is a global Business Process Management (BPM) leader. WNS offers business value to 400+global clients by combining operational excellence with deep domain expertise in key industry verticals, including Banking and Financial Services, Consulting and Professional Services, Healthcare, Insurance, Manufacturing, Retail and Consumer Packaged Goods, Shipping and Logistics, Telecommunications, Travel and Utilities. Globally, the group’s over 44,000+ Professionals serve across 60 delivery centers in 16 countries worldwide.

Job Description

  • Responsible for activities involving quality assurance and compliance with applicable regulatory requirements
  • Assist in developing and implementing quality management programs and initiatives
  • Knowledge of and experience with the Quality Assurance software/applications
  • Conducts quality monitoring reviews to include documentation of processes in relation to cases processed within each payor group
  • Ensure that performance standards are measured and developed uniformly for the contact center
  • Conducts coaching sessions with customer service representatives in regards to improvements sessions that are needed
  • Conducts quality assurance training as needed and facilitate weekly/monthly calibration sessions
  • Provide feedback to customer service supervisors/provide quality scoring and trends for individuals and team
  • Escalate patterns of serious performance issues
  • Participates in the HealthHelp Quality Management Program as required
  • Adheres to all state and federal regulations pertinent to the NT24 program

Qualifications

  • Has an active, current and unrestricted US RN license in any state or territory of the U.S.
  • Has minimum of 1-2 years of experience dealing with customers, providers, and/or members via the telephone
  • Has minimum of 2-3 years clinical experience as Emergency Nurse and Adult Care nursing
  • Previous Quality Assurance and/or work experience is preferred
  • Excellent verbal/written communication skills and presentation skills, including the ability to handle interactions with injured workers, employers, providers, members and various internal departments in a professional manner.
  • Be a highly motivated individual that can work effectively, independently and meet deadlines in an atmosphere of multiple projects and shifting priorities
  • Possess effective analytical/problem solving skills
  • Ability to use PC-based word-processing, database, and spreadsheet
  • Possess extensive knowledge of medical terminology and anatomy
  • Ability to speak English and Spanish fluently is preferred

Additional Information

All your information will be kept confidential according to EEO guidelines.

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