*Healthcare Quality Mgmt Consultant - A-Line Staffing Solutions : Job Details

Responsible for the review and evaluation of protected clinical information and documentation. Reviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues. Works on Potential Quality of Care cases (Medical), along with Patient Safety Events across all lines of business (Commercial, Medicare, and Medicaid). Independently coordinates the clinical resolution with internal/external clinician support as required. Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines. Applies critical thinking skills to assure case is reviewed by a practitioner with clinical expertise. Condenses complex information into a clear and precise clinical picture while working independently. Reports clinical findings to appropriate staff or others for follow-up as indicated. Critical In...Healthcare, Quality, Consultant, Health, Clinical, Technology, Staffing