1715 Rn Utilization Review S jobs near me

Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for underserved communities.

Best People, Best Solutions, Best Results

Job Summary:

Utilizes various data analysis tools and software (like SAS, SQL, Excel, R, Python, Tableau, etc.) to manipulate and analyze data, identifying trends in data to pinpoint variances, outliers, and percentile-ranked groups that provide actionable insight opportunities for quality improvement or in-depth investigations. Collaborates with other data analysts to create tabular and graphical presentations that clearly illustrate current levels of care, ensuring complex data is accessible and understandable for both technical and non-technical stakeholders. Contributes to the design of re-measurement strategies to assess the efficacy of interventions, leveraging analytical reports to effectively quantify their impact on healthcare improvement.

Essential Functions:

• Provides data preparation and cleaning. Conducts advanced data analyses including statistical modeling, machine learning, and predictive analytics to extract actionable insights. Develops and implements statistically sound sampling methodologies.
• Conducts most complex statistical analyses to derive meaningful insights and patterns from data, helping in decision-making processes.
• Develops and implements predictive models to help forecast future trends, aiding in proactive decision-making.
• Implements machine learning algorithms to automate processes, make predictions, and enhance analytical capabilities.
• Constructs sophisticated visualizations to communicate complex insights in a clear and concise manner to stakeholders.
• Collaborates with other departments and teams to understand business requirements and align analytical efforts with organizational goals.
• Delivers comprehensive and actionable reports that provide valuable information for strategic business decisions.
• Ensures adherence to data governance policies and compliance with relevant regulations to maintain data integrity and security.
• Helps to identify opportunities for process improvement, staying updated on emerging technologies and contributing to the ongoing enhancement of data analytics capabilities within the organization.
• Develops code to join multiple relational database tables required to conduct various analyses.

Level of Supervision Received:
Plans and arranges own work; works with manager to prioritize projects

Education (can be substituted for experience):
Minimum Bachelor's Degree required

Work Experience (can be substituted for education):
2 - 4 years of experience required; 5 - 7 years preferred

Certification(s):
Base SAS preferred

Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.

Qlarant is a drug-free workplace. All offers of employment are contingent upon successful completion of pre-employment background and drug screens.