Remote Insurance Utilization Review Jobs in Austin, TX

Location: Remote - Must reside in Texas

Facility: Ascension Care Management Insurance

Department: Quality Management

Schedule: Day Shift | Full-Time | Monday-Friday

Salary: $75,295.00 - $110,834.59 per year

Eligible for an annual bonus incentive

• Plan, design, implement, and maintain a comprehensive program of continuous quality improvement (CQI). Assists in educating new staff, providers about the quality improvement (QI) systems and requirements. Knowledge of quality improvement principles, practices and procedures.
• Oversees complex HEDIS project lifecycles-including data analysis, medical record abstraction, chase logic, thorough knowledge or Performance Improvement Projects (PIPs) and is able to apply that knowledge in PIP writing development, update, and analysis of data in PIPs.
• HEDIS experience, planning of the whole HEDIS project from start to end, how to complete the HEDIS Roadmap, understand the process and planning of medical record review and abstraction. Must be able to analyze HEDIS data to develop interventions for gaps in care.
• Maintains deep working knowledge of URAC/NCQA standards, the Uniform Managed Care Contract, and state-specific programs like Texas Health Steps and Alternative Payment Models.

Licensure / Certification / Registration:

• Certification specializing in Lean Healthcare Mgmt preferred.. Licensure required relevant to state in which work is performed
• Project Mgmt Professional preferred. Licensure required relevant to state in which work is performed
• Registered Nurse preferred. Licensure required relevant to state in which work is performed

Education:

• High School diploma equivalency with 2 years of cumulative experience OR Associate'sdegree/Bachelor's degree OR 4 years of applicable cumulative job specific experience required.

• Bachelor's Degree in Nursing is a must-have.
• 2+ years of Registered Nurse (RN) experience and 2+ years of HEDIS experience 
• Performance Improvement Projects (PIP)
• RN license in Texas

Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 97,000+ associates to bring their skills and expertise every day to reimagining healthcare, together. Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold Employer, you'll find an inclusive and supportive environment where your contributions truly matter.

Equal employment opportunity employer

Ascension provides Equal Employment Opportunities (EEO) to all associates and applicants for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy, childbirth, and related medical conditions, lactation, breastfeeding, national origin, citizenship, age, disability, genetic information, veteran status, marital status, all as defined by applicable law, and any other legally protected status or characteristic in accordance with applicable federal, state and local laws. For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.

Fraud prevention notice

Prospective applicants should be vigilant against fraudulent job offers and interview requests. Scammers may use sophisticated tactics to impersonate Ascension employees. To ensure your safety, please remember: Ascension will never ask for payment or to provide banking or financial information as part of the job application or hiring process. Our legitimate email communications will always come from an @ascension.org email address; do not trust other domains, and an official offer will only be extended to candidates who have completed a job application through our authorized applicant tracking system.

E-Verify statement

Employer participates in the Electronic Employment Verification Program. Please click here for more information.

Paid time off (PTO)Various health insurance options & wellness plansRetirement benefits including employer match plansLong-term & short-term disabilityEmployee assistance programs (EAP)Parental leave & adoption assistanceTuition reimbursementWays to give back to your community

Benefit options and eligibility vary by position. Compensation varies based on factors including, but not limited to, experience, skills, education, performance, location and salary range at the time of the offer.