Remote Quality Review Nurse
- Job Locations: Remote
- Job ID: 2019-7382
- Category: Clinical / Utililization Management
Help us keep patients on the path to the ultimate site of care: home. CareCentrix is committed to making the home the center of patient care.
We are currently hiring for a Quality Review Nurse – Remote job responsible for supporting quality improvement initiatives aimed at achieving and maintaining a high standard of care and service excellence to CareCentrix’s patients, Health Plan customers, and accredited Providers.
CareCentrix is a growing organization and we are seeking dedicated individuals to be a part of this exciting and rewarding business. We offer competitive pay and a full benefit package including health, dental, vision, 401K, and tuition reimbursement.
- This position assists in the clinical quality of care review process, the medical record audit process for the delegation oversight, quantitative and qualitative analysis of data & transformation in information that can be reported
- Performs delegation oversight activities including auditing medical record against Medical Care guidelines, Scope of professional practice standards and policies and procedures etc. to determine compliance with established standards
- Extracts data from systems and records and conducts quantitative and qualitative analysis of data & transformation into information that can be reported
- Communicates audit results to delegated entities along with education about best practices, and maintains that information in the appropriate files
- Performs review of clinical quality of care issues through CART reporting & review of the patient satisfaction results
- Performs medical record reviews using applicable inclusion and exclusion criteria and methodology (sampling, randomization, etc.) to identify patients and/or indicators for review/study, to obtain very accurate, valid, reliable data. Summarizes and presents data as requested
- Audits care and individual cases as indicated to monitor and promote compliance with criteria and utilization guidelines
- Participates in implementing / maintaining operational processes to promote compliance with Company policies, legal requirements and regulatory mandates.
- Associate’s degree/Bachelors or Master’s degree preferred with current Registered Nurse license in the state(s) of practice without restrictions and a strong clinical background as an RN.
- Certified Professional Health Care Quality (CPHQ) preferred.
- 3-5 years of Quality Management and/or UM in a managed care environment.
- Prior experience with medical record review, complaint review, investigation and tracking.
- Past experience with data collection and analysis of indicators for monitoring and evaluation of quality, appropriateness and timeliness of care and service, and customer satisfaction. Must have excellent skills working with Microsoft Office applications such as Excel and Power-Point and familiarity with navigating databases.
- Adheres to and participates in Company’s mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices.