Job Title: Quality Coach

Job Description

Support the company's adherence to processes within Utilization Management and Case Management. This role includes reviewing and performing denial letter validation, ensuring quality in all aspects of denial letters. The position may also involve call quality assurance, using AWS systems to listen to calls for compliance, ensuring adherence to HIPAA requirements.

Responsibilities

• Perform denial letter validation to ensure quality and adherence to processes.
• Conduct call quality assurance using AWS systems to ensure compliance with HIPAA requirements.
• Support Utilization Management and Case Management processes.
• Evaluate, coach, and mentor others in complex operational processes or health services-related quality reviews.

Additional Skills & Qualifications

• Completion of an accredited registered nursing program.
• Active and Unrestricted Registered Nurse (RN) license in Iowa or South Dakota.
• 4+ years of clinical or equivalent industry experience.
• Strong communication skills for articulating complex information.
• Ability to establish and maintain positive relations with colleagues, stakeholders, and customers.
• Analytical skills for evaluating data/trends and solving practical problems.
• Experience with Microsoft Office Suite and electronic charting/documentation systems.
• Technical aptitude to learn new systems.
• Interrater Reliability Certification (IRR) preferred.

Work Environment

This is a 100% fully remote position, requiring 40 hours per week with availability from 8 am to 5 p.m. The contract is anticipated to cover parental leave, with a target start date no later than the end of May and expected to continue through August 2025.