| Location | MN |
At the direction of the Supervisor, Quality & Training, assists in the overall clinical quality and clinical standards in LTCG's case underwriting area. Performs random on-going quality audits for the underwriting staff, identifies and assists with training needs, clinical criteria review and external audits.
Complete regular underwriting decision quality audits for all clients as well as internal ad hoc audits. Provides written feedback to the underwriter and supervisor as indicated. Provides quality feedback to underwriting leadership at the time of performance appraisals for exempt level underwriting staff. Provides written quality audit summaries, reporting to clients as required by contract language (weekly, monthly or quarterly) and participates in client discussions regarding quality and audits.
Assist to identify training needs, develop teaching materials, and provide training to clinical staff based on the quality review, changes in clinical practice, on-going education needs, or new staff.
May assist with case consults for all levels of underwriters either verbally or written
Using clinical knowledge and underwriting expertise, assists with best practice and criteria manual reviews making recommendations for changes as indicated
Assists to update and maintain:
PHI & F2F assessment tools
ICD-9/ ICD-10 coding schemes in LTCAS & CLTCAS
Drug lists in LTCAS & CLTCAS
Assist on ad hoc projects as requested