Company Overview: Job Description:

This is a full time, hybrid position and will require in-office work on a weekly basis. Candidate needs to be located in the Dallas, TX area.

• Performs quality assurance review of IME/ peer review reports, correspondences, addendums or supplemental reviews.
• Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
• Ensures that all client instructions and specifications have been followed and that all questions have been addressed.
• Where required ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.
• Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
• Ensure that the appropriate medical specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.
• Verifies that the reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.
• Ensures the provider credentials and signature are on the final report.
• Identifies any inconsistencies within the report and contacts the reviewer to obtain clarification, modification or correction as needed.
• Assists in resolution of customer complaints and quality assurance issues as needed.
• Ensures all federal ERISA and/or state mandates are adhered to at all times.
• Provides insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.
• Promote effective and efficient utilization of company resources.
• Participate in various educational and or training activities as required.
• Perform other duties as assigned.
• Has an excellent command of grammar and medical terminology
• Meets specific department metrics
• Operates company software and equipment
• Enters data by inputting alphabetic and numeric information into system via keyboard
• Maintains confidentiality and discretion as a general rule
• Works effectively as a team contributor on all assignments
• Interacts professionally with other employees as well as clients
• Has a clear and concise understanding, and adheres to, guidelines as they relate to HIPAA, Conflict of Interest, and Ethics
• Understands current URAC standards as appropriate to job functions

Qualifications:

• HS Diploma or equivalent
• Relevant industry related experience (IME/Peer Reviews, Legal, Claims experience)
• Remote employees in this position will be expected to ensure the protection of proprietary Company and customer information accessible from their home or satellite office. Steps include, but are not limited to, use of locked file cabinets, disk boxes and desks, regular password maintenance, and any other steps appropriate for the job and the environment
• LPN/RN Degree a plus - Where applicable, employee must notify the Quality Manager immediately of any changes in professional active license status for any state license is being utilized for current position or current certifications status
• Proficient with MS Office Suite
• Excellent communication skills-verbal and written
• Ability to organize and prioritize work effectively
• Ability to accept and apply constructive feedback

Benefits : We’re committed to supporting your ultimate well-being through our total compensation package offerings that support your health, wealth and self. These offerings include Medical, Dental, Vision, Health Savings Accounts / Flexible Spending Accounts, Life and AD&D Insurance, 401(k), Tuition Reimbursement, and an array of resources that encourage a lifetime of healthier living. The Company is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability. #LI-EG1 #REMOTE #GNX