Utilization Management QA RN

UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage complex admin tasks, allowing our customers to prioritize members’ well-being. With our commitment to simplicity, honesty, and leadership, we navigate challenges with our customers to achieve affordable health care for all. We have a strong global presence and a dedicated workforce of over 4000 people spread across the world. Our brand is built on the strong foundation of simplicity, integrity, people-centricity, and leadership. We stay inspired in our goal to unburden healthcare and ensure it reaches all, equitably and effectively.

The Utilization Management QA RN is responsible for providing clinical and educational support assessments, analysis and coordination of the quality management program and assisting in the divisional accreditation process. Role Location: Remote Compensation Range: $65,000-$85,000

Responsible for training UM clinical staff on processes, policies, and systems. Participate & lead in the development, implementation, and updating of training manuals to reflect new approaches to training, departmental and/or system process changes and MCG criteria updates as needed. Oversee and mentor new employees during the initial training program. Work closely with the leadership team, QA, and subject matter experts external and internal to assess the learning environment and determine relevant resources for training. Educate staff in the clinical policies criteria and procedures of MCG as well as an overview of the department, general functions, responsibilities and department relationships with other departments. This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.