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Quality Review Manager
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- The Quality Review Manager is responsible to work autonomously to complete full audit, review and approval of the following, but not limited to: Life Care Plans, Medical Cost Projections, Medicare Set-Aside Allocations, Legal Nurse Reviews, Complex Nurse Reviews, Bill Reviews, initial and progress reports for medical or vocational case management files and other reports as needed within the scope of nursing practice and certifications.
- The Quality Review is responsible to monitor the overall quality of all the work products and effectively communicate with the planner team to include development of alternative treatment plans or recommendations for moving the file toward maximum resolution at the highest level of quality and timeliness possible.
- Ensure all federal Centers for Medicare and Medicaid Services (CMS) requirements and/or state mandates are adhered to at all times.
- Three to five years Medicare Compliance preferred and a minimum of three years worker’s compensation experience.
- Must have minimum active certification in Medicare Set-Asides; additional certification in Life Care Planning and/or Legal Nurse Consulting preferred.
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