Description

Job Description Summary
Plans, designs, develops and performs quality assessments on data elements and structures to document and evaluate integrity, completeness, quality, and appropriateness of formats, records and structures. Configures, operates and develops manual and/or automated methods, processes and procedures to test output or input based on data compliance, quality and use requirements as established by product management, client specifications, and governance programs. Performs regular and ad hoc reviews, audits, and investigations of data activity and integrity; prepares reports and summaries of findings. Produces and updates guidelines and documentation of test development processes, procedures and standards.

Requirements

Complete record reviews on client records to identify best practice process improvement opportunities

Complete data analysis of reviews completed and create summary presentations for internal and external communication of record review results

Engage with client utilization management teams and provide feedback regarding record review and education associated with identified opportunities for best practice improvement

Develop and provide education regarding clinical concepts to clients and internal stakeholders and product designers

Product Innovation:

Participate in product performance audits and communicate results with product team

Perform medical record review to support product innovation and development

Audit performance of key data science conditions and elements

Additional Job Description
Bachelor’s Degree or equivalent in Nursing (RN)

5+ years of experience in utilization management and/or clinical documentation and auditing clinical documentation

Self-starter, who is extremely motivated to demonstrate success

Attention to detail, highly organized, with an absolute focus on quality of work

Team player DNA with a desire to solve for the interests of our clients and of our business