Mitchell International, Inc.

Nurse Reviewer, Utilization 3

US-CO
Job ID
17-7721
Type
Regular Hire

Company Overview

 

 

Mitchell International, Inc. is a leading provider of information and workflow solutions to the Property & Casualty Claims Industry and their supply chain partners. We solve interesting and complex problems that directly affect the customers our clients serve. We are constantly adapting to stay on the forefront of emerging technologies and we work diligently to maintain our position as a thought leader within our industry.

 

Mitchells workers compensation national managed care program offers solutions for insurance carriers, third-party administrators and employers. We recommend an integrated suite of solutions that include utilization review and case management with a focus on managing total claims costs while expediting safe return to work.

 

Job Description

Clinical QA/Trainer: Facilitates objective and systematic measurement, monitoring and evaluation of the quality of Mitchell International Managed Care services through quality management audits and education. Uses audit outcomes to plan and conduct efficient processes via QIPs, staff training and analyses of existing processes. Works as liaison with software developers to improve efficiencies and throughput, while maintaining quality standards. Facilitates standardization and optimization of processes across Mitchell's managed care processes.

Qualifications

Current, valid professional health clinical license required for clinical auditing, with certification in utilization management and/or case management preferred.

 

Three or more years’ experience in disability management and/or utilization management.

 

Knowledge and understanding of the worker’s compensation or property/casualty insurance industry and healthcare delivery system.

 

Previous Quality Assurance experience preferred, but not required.

 

Well developed communication and interpersonal skills. Works well within a team setting to achieve the provision of the highest quality of results oriented service.

 

Proficiency in Microsoft Office suite required.

 

Strong verbal and written presentation skills.

 

Proficient use of databases and data analysis to develop customer oriented operational excellence.

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