Group Health QA Supervisor - RN

Position Overview

• Location Type: Remote
• Job Type: Not Specified
• Salary: Not Specified

The QA Supervisor is responsible for the oversight of the review of Physician reports and accompanying medical records to ensure that the report is complete, accurate, and consistent with medical evidence. This role involves the oversight of QA staff, ensuring appropriate staff are assigned to each file to designate file handling responsibilities amongst the team. The supervisor will manage the File Review Board to ensure a timely and accurate process of each file and provide details of board reviews to managers to ensure efficiency and productivity of staff. Additionally, the QA Supervisor will assist in identifying and correcting staff performance, including promotions, discipline, coaching, and termination of staff, as well as assist in hiring qualified candidates for QA open positions. The role requires ensuring that all QA staff adhere to and meet their specific job duties, including:

• Following up with Physicians for outstanding reports
• Reviewing received reports for accuracy
• Delivering completed reports back to all applicable parties
• Following all client-specific instructions

The QA Supervisor will actively participate in issue resolution by working with the required QA, physicians, account managers, and/or other related parties. A key responsibility is to ensure referrals meet the client-directed Turn Around Time (TAT) and to act as the liaison between the reviewer, team member, and client regarding the process or status of the file. Other duties and special projects, as assigned and based on business needs, will also be part of this role.

Requirements

• Education/Credentials: An Associate’s Degree or Bachelor’s Degree is preferred. RN licensure is required.
• Job Relevant Experience: Medical peer review or healthcare industry knowledge is required. Business experience in a healthcare and/or insurance setting is preferred.
• Job Related Skills/Competencies:
  • Exceptional communication skills with a clear understanding of company business lines.
  • Ability to apply critical thinking, manage time efficiently, and meet specific deadlines.
  • Computer literacy and typing skills are essential.

Responsibilities

• Oversee the review of Physician reports and medical records.
• Supervise QA staff and assign file handling responsibilities.
• Manage the File Review Board to ensure timely and accurate file processing.
• Provide updates to managers on board reviews and staff productivity.
• Assist in staff performance management (promotions, discipline, coaching, termination).
• Assist in hiring qualified QA candidates.
• Ensure QA staff adhere to job duties, including following up with physicians, reviewing reports, and delivering completed reports.
• Actively participate in issue resolution.
• Ensure referrals meet client-directed Turn Around Time (TAT).
• Act as a liaison between reviewers, team members, and clients.

Application Instructions

• Not Specified

Company Information

About Dane Street: A fast-paced, Inc. 500 company. (Further details needed)

Benefits:

• Medical, dental, and vision coverage for you and your family.
• Voluntary life insurance options.
• Hospital indemnity, critical illness, accident indemnity, and pet insurance plans.
• Basic life insurance, short-term disability, and long-term disability coverage at no cost.
• Generous paid time off policy.
• 401k plan with a company match.
• Apple equipment and a media stipend are provided for remote workspace.