Disability Clinical RN Quality Assurance Specialist, Dane Street, LLC, US

Overview:

Dane Street is seeking highly motivated candidates to join our team as a Clinical (RN) QA Specialist, specializing in Disability. We offer an exciting work environment, competitive compensation, and strong growth potential.

Summary:

As a Clinical (RN) QA - Disability Specialist, you will leverage your expertise in long-term disability claims to review and ensure to accuracy and completeness of reports accompanying medical records. You will communicate with physician reviewers and their teams to ensure clarity of information, address all posed questions, and meet client deadlines.

Key Responsibilities:

• Assess the quality of physician reports, ensuring they meet all client and jurisdictional standards specific to long-term disability claims.
• Verify that the claims support the physicians determinations in long-term disability claims.
• Read and apply policy guidelines and healthcare terminology, determining when criteria for long-term disability are met.
• Provide strong customer service by working closely with clients on a case-by-case basis to deliver complete, timely, and error-free quality assurance for long-term disability cases.
• Manage and provide oversight for complex long-term disability cases requiring additional review prior to returning to the client.
• Serve as an additional level of QA for cases with quality issus, utilizing clinical claims knowledge specific to long-term disability.
• Participate in other duties and special projects, as assigned, based on business needs.