RN Training and Quality Assurance Coordinator

Location:

This position is full-time (40-hours/week) Monday-Friday from 8:00am-4:30pm EST and will be hybrid in Columbia, SC. The candidate will be required to report on-site occasionally for trainings, meetings, or other business needs.

What You'll Do:

• Reviews medical review decisions for accuracy and to ensure CMS instructions have been applied correctly.

• Develops/implements the quality control program used as an intense review of clinical staff's technical knowledge and evaluation of medical judgment ability. Provides feedback to management and staff, and, if necessary, provides remedial training.

• Assists provider service departments with medical coverage issues to ensure continuity of application of CMS guidelines. Responds to specific provider inquiries and appeals requests.

• Develops and maintains departmental reference manuals used for proper application of CMS instructions.

• Provides continuing education workshops on coverage issues and medical advances.

• Trains new staff on CMS guidelines and medical review procedures. Coordinates system access and security clearance of new staff.

• Creates monthly reports for management outlining quality control results, adjustment data, and reopen results summary.

• Provides input to medical review audit department regarding actions taken in response to provider billing practices in order to target program abuse.

To Qualify for This Position, You'll Need the Following:

• Required Education: Associates in a job-related field

• Degree Equivalency: Graduate of Accredited School of Nursing

• Required Work Experience: 4 years' combination of clinical, utilization review, training, quality assurance, or case management experience.

• Required Skills and Abilities: Excellent verbal and written communication, customer service, organizational, and analytical or critical thinking.

• Good judgment.

• Proficient spelling, grammar, punctuation, and basic business math.

• Ability to persuade, negotiate or influence, and handle confidential or sensitive information with discretion.

• Knowledge of mathematical or statistical concepts and medical terminology.

• Required Software and Tools: Microsoft Office.

• Required Licenses and Certificates: Active unrestricted RN licensure in state hired, OR active unrestricted compact multistate RN license as defined by the Nurse Licensure Compact (NLC).

Our Comprehensive Benefits Package Includes the Following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• Subsidized health plans, dental and vision coverage

• 401k retirement savings plan with company match

• Life Insurance

• Paid Time Off (PTO)

• On-site cafeterias and fitness centers in major locations

• Education Assistance

• Service Recognition

• National discounts to movies, theaters, zoos, theme parks and more

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.comor call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's moreinformation.

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