Clinical Quality Assurance Specialist

Job Title

Workplace well-being is more important than ever. We are the winner of the 2018, 2019, 2020, 2021, 2022, and 2023 Best and Brightest Companies to Work for In the Nation. We have also won the 2020 Best Places to Work Award, Minneapolis/St. Paul Business Journal.

Our employees benefit from a competitive benefits package that includes paid time off (PTO), paid parental leave, paid holidays, insurance (medical, dental, vision, life, STD, LTD), flexible schedules, a 401k program with company match, and profit sharing. Insurance benefits are effective on the 1st of the month following month of hire.

We strive to develop and provide growth opportunities for our employees. In 2022, R3 Continuum spent approximately $32,500 on employee training and development.

At R3 Continuum, we believe our differences don't divide us but teach us. R3 Continuum eagerly embraces diversity and is a committed Equal Opportunity Employer to all qualified applicants, ensuring individuals will not be discriminated against based on any protected classifications.

Join a company dedicated to helping people and organizations be more resilient and thrive.

Essential Functions

• Complete quality assurance reviews on each report (file reviews and evaluations), letter, and appendix and provide clear and concise edits to the specialist, ensuring that reports and case documents are error free and delivered on time to the customer
• Review for consistency and clarity of content
• Ensure network specialist answers all questions requested by customer
• Review completeness of all reports, letters, and appendices, ensuring that all customer instructions were followed by the network specialist
• Identify potential clinical content inconsistencies and collaborate with Clinical Manager, Quality Assurance, and/or Clinical Subject Matter Experts as needed, including clarification reports
• Facilitate and document panel calls between network specialists as needed
• Send letters to attending physicians via fax or mail
• Send finalized reports and case documents to customers

Identify network panelist quality issues and resolve issues by providing feedback/training to the network panelist and, if necessary, referring the network panelist back to the Training Department based on available data

• Demonstrate proficiency in using R3 Continuum's online portal [eCase Manager (eCM)] as it relates to QA tasks
• Document all communications with network specialists and work completed in eCM
• Monitor workload through use of eCM reports
• Maintain confidentiality utilizing HIPAA guidelines

Secondary Functions

• Assist in gathering case documents for legal records requests, as needed
• Participate in process improvement identification and solutions, including completion of special projects
• Participate in department and company meetings, as requested
• Perform other duties as assigned
• Overtime/Additional Hours – There are times in which overtime/additional hours will be mandatory due to an increase in work and the need to meet turnaround timeframes

Requirements

Required Skills/Abilities:

• Ability to develop and foster relationships with employees, network panelists, and customers at all levels of the organization.
• Comfort and ability to give clear, consistent, and concise direction and communication with network panelists (RNs, psychologists, physicians) and team members.
• Good judgment with the ability to make timely and sound decisions based on data and business acumen
• Ability to recall important and commonly used QA concepts and to independently apply concepts learned to multiple areas
• Familiarity with medical and mental health terminology
• Highly proficient with verbal and written communication
• Excellent grammar and spelling skills
• Excellent interpersonal and customer service skills
• Excellent organizational skills and attention to detail
• Ability to multitask and to quickly switch between two unrelated tasks
• Excellent time management skills with a proven ability to meet deadlines
• Strong critical thinking, analytical, and problem-solving skills
• Ability to function well in a high-paced and at times stressful environment
• Proficient with Microsoft Office Suite or related software
• Basic mathematics skills

Education & Licensing:

• Bachelor's degree required, preferably in psychology or behavioral health
• Master's degree preferred, preferably in a human or natural science, from an accredited college or university

Experience:

• 3 years of previous experience reviewing reports with medical, behavioral health, and/or scientific content; preferred
• 3 years of previous experience working and communicating with medical professionals; preferred
• 3 years of previous experience in the disability or workers' compensation insurance industry or similar; preferred

Physical Work Requirements:

Work is generally sedentary in nature but may require standing and walking for up to 10% of the time. Lighting and temperature are adequate, and there are no hazardous or unpleasant conditions caused by noise, dust, etc. Work is generally performed within an office environment, with standard office equipment available.

Salary Description $20.60-23.17/hr