Role overview

Qualifications

Registered Nurse (RN) license
Experience in clinical quality review
Critical thinking and clinical judgment skills
Ability to analyze quality issues

Responsibilities

Investigate and review potential quality of care issue allegations
Analyze quality issues from both internal and external sources
Perform case reviews and follow up actions as per department protocols
Prepare cases for physician committees and corrective action plan requests

Key facts

Remote from: California (USA)
Full time
Nurse
English

Hard skills

Clinical Quality Management Case Assessment Evaluation Of Care Presentation Training Corrective Action Training

Other skills

Critical Thinking
Investigation
Time Management
Communication

About the company

ICONMA

Human Resources, Staffing & Recruiting

We provide Professional Staffing Services & Project-Based Solutions for a broad range of Fortune 500 organizations. ICONMA is a certified Woman-Owned staffing company and was founded in 2000. ICONMA’s corporate headquarters is in Troy, Michigan, and has 15+ locations worldwide. What makes ICONMA stand out in a fiercely competitive industry? *We provide integrated, full lifecycle services across a broad range of business and technical platforms. *No single company can duplicate our full range of staffing and permanent recruiting services nationwide. *Proven track record of attracting and retaining exceedingly skilled professional workers in a highly competitive market. SERVICES OFFERED Staff Augmentation (Contract, Contract to Hire, Direct Hire, Single Source) Data Analysis Project-Based Services & Solutions Hire Train Deploy Service Model Offshore Staff Augmentation Payroll Services AREAS OF EXPERTISE - Information Technology - Engineering - Business Professional - Accounting/Finance - Admin/Clerical/Call Center - Healthcare/Clinical/Scientific - Marketing/Creative mail linkedin@iconma.com Phone (888) 451-2519 Website http://www.iconma.com

Company details

Company typeLarge

IndustryHuman Resources, Staffing & Recruiting

Company size1001 - 5000

Links

Website LinkedIn See all jobs

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Job description

Our Client, a Health Insurance company, is looking for a Nurse RN 3 for their Remote location.

Responsibilities:

The Clinical Quality Review (CQR) team investigates and reviews potential quality of care issue (PQI) allegations or concerns arising from member grievances and internal referrals.
PQI reviews may confirm a quality problem that resulted in or had the potential for harm to the member and can lead to identification of provider opportunities for improvement related to practice patterns that are outside the framework of accepted standards.
The Clinical Quality Reviewer will report to the Manager, Clinical Quality Review.
In this role, you will be responsible for reviewing PQI cases per department protocols through various levels of review and executing follow up actions.
Analyze quality issues from both internal and external sources
Thoroughly investigate, apply critical thinking and clinical judgment to appropriately identify quality of care issues
Determine appropriate level of case review needed which may include escalating cases to a medical director, Peer Review Committee or Credentialing Committee to render a final determination
Prepare cases for presentation at physician committees as indicated
Prepare corrective action plan requests for cases where it is deemed necessary for the provider to institute a change in their present practice
Present and discuss corrective action plan responses with medical director and/or Peer Review Committee
Manage assigned case load to meet all timeliness metrics
May perform clinical oversight

Why Should You Apply?

Health Benefits
Referral Program
Excellent growth and advancement opportunities