Responsibilities

• Collection and analysis of data  pertinent to UR reviews
• Development of Quality Improvement Performance (QIP) indicators based on collection and analysis to identify opportunities for improvement
  
• Implement approved QIP and ensure at least 2 per year in progress
  
• Staff training to include documenting tool, phone skills and report preparation
  
• Review of staff performance
  
• Present results of data analysis, QIP and other pertinent information to the CMO and QA committee.

• Assure compliance with all URAC
  

Requirements

• BS or BA Required with RN or MD
  
• Minimum of 3 years prior experience with QA/QI programs
• Six-sigma or similar training a plus
  
• American Board of Quality Assurance and Utilization Review Physicians certification a plus
  
• Knowlege of applicable laws, rules, regulations, URAC policies and procedure for Utlization Review
• Excellent communication skills
• Excellent organizational skills