RN Utilization Reviewer
Summary
Title:RN Utilization Reviewer
ID:1432
State:N/A
County:Cincinnati, Columbus, Cleveland, and Marietta
Program Type:Field Based
Position Type:Full Time
Department:Program Management
Description

CareStar is currently seeking an RN Utilization Reviewer to develop and implement continuous quality improvement activities across CareStar’s programs and services. This is a remote/work form home position. 

At CareStar, our employee’s share in the equity of the company through a shared ownership benefit, the CareStar Employee Stock Ownership Plan (ESOP).

If these responsibilities, qualifications and benefits match your background, apply today at CareStar’s Career page at www.carestar.com.


Job Responsibilities:

  • Directly supervises, manages, and oversees staff, including hiring and providing performance evaluations, salary recommendations, and individual development goals and objectives.
  • Oversees quality improvement activities in assigned area of the State, such as data collection, monitoring, and reporting quality improvement functions.
  • Leads and/or participates in key committees associated with continuous quality improvement, staff education, and/or consumer health and safety issues.
  • Collaborates with Directors to design and conduct reviews of select processes and/or areas of operation to measure performance on quality and compliance indicators; assimilates data from these reviews, provides recommendations for improvement and presents findings to senior management.
  • Develops and implements quality improvement related processes and tools such as chart audits, consumer satisfaction surveys, focused reviews, ongoing data monitoring mechanisms, etc.
  • Monitors compliance of After-Hours requirements, including the review of the On-Call Log for complete and appropriate responses; oversees the preparation of summary records for annual reviews; monitors and facilitates reporting of incidents per protocols.
  • Coordinates/oversees After Hours coverage and supervises After-Hours Coordinators and additional CareStar staff, as assigned.
  • Develops and maintains systems for collecting, recording, tracking, trending, and analyzing consumer and other quality outcome data for use and benefits statewide, or within a CareStar department or department subsection as assigned.
  • Serves on work groups, community groups, committees, or other task forces and attends meetings as requested.
  • Participates in sales presentations, RFPs, RFIs and other proposals.
  • Performs other projects and duties as assigned.
  • Adheres to the CareStar Rule in performance of job responsibilities.
  • Understands and complies with CareStar Policies and Procedures.
  • Maintains confidentiality as related to patient information. Any disclosures of confidential information made unlawfully outside the proper course of duty will be treated as a serious disciplinary offense.
  • Follows the Acceptable Use Policy while using any information systems owned or controlled by CareStar, Inc.

Qualified candidates will have the following knowledge and experience:

  • Registered Nurse and at least 36 months of experience in the home and community-based services within the last 10 years; OR Bachelor’s Degree in Nursing, Medical Records/Coding or related field and at least 60 months of program management or program analysis experience.
  • Experience with continuous quality improvement principles, data analysis and basic statistics.
  • Supervisory experience preferred.
  • Strong organizational, critical thinking, and problem solving skills.
  • Effective oral and written communication skills.
  • Familiarity with suite of Microsoft Office programs.
  • Valid driver’s license and car insurance as required by State law

CareStar offers a competitive salary, based upon experience, education and knowledge; paid vacations and holidays; insured medical plans for employees and their families and 401(k) with a generous Safe Harbor company matching contribution.

We believe that people work best when they are working for themselves. At CareStar, our employee’s share in the equity of the company through shared ownership benefit, the CareStar Employee Stock Ownership Plan (ESOP).

CareStar is an equal employment opportunity employer (EOE/m/v/d/f) committed to excellence through diversity.


About CareStar

CareStar was founded in 1988 in Cincinnati, Ohio and continues as an industry leader in the field of Long-Term Care Case Management, Assessment and Innovative Software Development Solutions.

CareStar’s Mission is “Improving Communities by Improving Lives.” Our services are currently delivered in Ohio, Indiana, Kentucky and Georgia and are designed to support individuals with chronic health conditions and/or disabilities to live safely in their communities and as independently as possible.  In addition, CareStar provides software services (e.g. application development, report writing, data management, query development) for healthcare organizations and government entities and e-learning opportunities to support the continuing education for various healthcare related credentials (e.g. RN, STNA, LSW, Home Health Aides, Personal Care Technicians, Certified Nursing Assistants, etc.).

CareStar has a proven track record of designing tailored programs to meet the needs of the customers we serve. In addition to possessing the rigorous HITRUST Certification for data security, CareStar is accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) with commendation, has an A+ rating with the Better Business Bureau and was a 2017 Goering Center Family and Private Business Finalist for Private Businesses with more than 101 employees.

This opening is closed and is no longer accepting applications
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