AllMed Healthcare Management

QA Engineer

• Perform quality utilization reviews using acquired knowledge and evidence-based guidelines
• Review and approve care based on medical necessity and appropriateness
• Prepare and review peer review reports, correspondence, addendums, and supplemental reviews
• Work directly with providers to identify level, intensity, and duration of care
• Document findings and evaluate medical necessity for frequency, intensity, and length of care
• Ensure review consistency and quality meets or exceeds industry standards
• Complete quality reviews within client, federal, state, and URAC-mandated turnaround times
• Maintain and apply knowledge of URAC and state and federal regulatory requirements
• Maintain accurate utilization review records in the appropriate database
• Direct Customer Service Representatives to ensure timely delivery of determination letters
• Assist with client complaints and quality assurance issues
• Ensure adherence to federal ERISA, URAC, and other state guidelines
• Provide management with insight and direction on compliance concerns
• Participate in company meetings, training activities, and continuing education
• Perform other assigned duties

Explore Clinical Quality Assurance Coordinator at AllMed Healthcare Management. Review requirements and application details.

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Clinical Quality Assurance Coordinator