Quality Program Coordinator, RN HealthHelp, Inc.
THIS JOB HAS EXPIRED Job Description
Performs credentialing of all MD?s, RN?s, LVN?s, LPN?s and any other licensed contractor or employee of HealthHelp according to policies and procedures of HealthHelp.
Refers calls to Director of Quality per guidelines and/or at the request of any caller.
Provides quality customer service through interaction with providers, health plans administrative staff and others.
Collects and enters confidential information ensuring the highest level of confidentiality in all areas.
Audits written documentation according to HealthHelp?s documentation policy and approved abbreviation list.
Provides ongoing telephonic education to providers and office staff related to HealthHelp?s process.
Reviews clinical intake received via phone, fax, IVR, or web against documented clinical notes to determine if criteria are met appropriately in the audit process.
Participates in the HealthHelp Quality Management Program as required
Assists to maintain and keep up-to-date all databases with accuracy
Adheres to all HIPAA, FWA, Consumer Health and Safety and all state and federal regulations pertaining to the clinical programs
Adheres to both URAC & NCQA standards pertinent to their job description
Current license as Registered Nurse, RN
QA experience required
Prior clinical experience in direct clinical care and managed care
This position is not remote.
Houston, Texas, United States
||Houston, TX |
THIS JOB HAS EXPIRED