Quality of Care Analyst
5 days ago
This role entails investigating and processing complex appeals and grievances, reviewing services for medical necessity, preparing documentation, and collaborating with the Medical Director.
You will also be responsible for documenting and logging appeal/grievance information, generating written correspondence, and serving as a subject matter expert for appeals, grievances, and quality of care issues.
Requirements and Qualifications- A minimum of 2-4 years of clinical experience, preferably in acute patient care, discharge planning, or case management
- Prior experience with appeals and grievances is necessary
- Demonstrated clinical knowledge and experience relative to patient care and healthcare delivery processes
- Medicare Advantage experience is preferred
- Exceptional written and verbal communication skills
- Strong customer service and interpersonal skills
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