logisticare

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Quality Assurance Manager

at logisticare

Posted: 10/24/2017
Job Reference #: 5000273034506
Keywords:

Job Description

Job Title

Quality Assurance Manager

Requisition Number

17-5558

Job Description

The Utilization Review Nurse Manager will be responsible for reviewing non-emergency medical transportation requests for stretcher, ambulance and wheelchair transport. They will obtain appropriate medical information to make medical determinations and will work closely with LogistiCare staff to assist in quality assurance of these trips. The UR Manager will develop policies and procedures for the medical UR function and will manage and direct a small team of employees.

Essential Functions and Responsibilities:

  • Review all ambulance and stretcher trips to assure appropriate utilization of resources
  • Screen all medical documentation and make decisions based on provided information to determine the most efficient and appropriate method of transport or most appropriate medical provider
  • Work closely with Quality Specialist to ensure all approved trips are entered correctly into EDS system
  • Maintain client confidentiality by compliance with HIPPA guidelines and LogistiCare confidentiality policy
  • Act as a resource for LogistiCare staff for all medical questions
  • Actively work with the Operations Management team on overall QA Plan for Connecticut operations

Other Duties and Responsibilities:

  • Make suggestions for and updates policies and procedures as needed
  • Maintains all confidential client information in files
  • Destroys confidential information when appropriate by shredding
  • Participates in in-services as needed or requested by manager
  • LogistiCare is an affirmative action-equal opportunity employer.

Knowledge and Skills:

  • RN with active state license
  • Supervisory experience and ability to manage and lead a small team of employees
  • Strong Utilization Review professional background preferred or at least 4 years recent clinical experience
  • Exceptional interpersonal skills with excellent written and verbal skills
  • Knowledge of clinical UR and QA, Medicaid, Medicare guidelines and covered services
  • Broad knowledge of health care system including hospital, nursing home and community medical knowledge
  • Computer proficiency with Microsoft Office, Excel, and Access
LogistiCare is an affirmative action-equal opportunity employer.

Work Location(s)

30 Chapel View Blvd Suite 110, Cranston, Rhode Island 02920

Full-Time/Part Time

Full-time

Requirements