Rn Quality Review Jobs

•Prior experience with project facilitation/management preferred.

•Maintains hard copy documentation in accordance with contractual requirements.

•Knowledge and understanding of QI functions in an MCO preferred

•Knowledge of Medicaid and Medicare preferred

Associate’s Degree or equivalent work experience

•Prepares meeting packets, schedules meetings, develops agendas, completes minutes, and chairs the Internal Quality Review Committee (IQRC).

The responsibilities listed are a general overview of the position and additional duties may be assigned.

Performs quality review and edits of documents.

Assists in analyzing document content and designing intervention and training materials.

Identifies areas for improvement in production process.

Identifies trends/issues in preliminary data and report trends/issues.

Assists in the implementation of interventions.

Some Of Our Unique Benefits We Offer Include

Bachelor’s degree in nursing preferred; relevant experience may be substituted for degree.

Proficiency with analysis, facilitation and evaluation. Knowledgeable of CMS and Joint Commission Core measure standards and regulations.

What Qualifications You Will Need

401k (100% annual match - 3%-9% of pay based on years of service

Auto, Home, and Life Insurance options

1-2 years of experience in administrative or records management.

Are you an experienced Review Assistant looking for a new challenge?

Associate’s Degree and/or equivalent work experiences related to medical, behavioral, or social/support settings.

Knowledge of general review of records, claims or requests in a healthcare related field.

Knowledge the organization of medical records, medical terminology, disease process.

Working knowledge of software with healthcare or insurance application.

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Identifies appropriate benefits and eligibility for requested treatments and/or procedures.

Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.

Analyzes clinical service requests from members or providers against evidence based clinical guidelines.

Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members.

Processes requests within required timelines.

Superior time management and multi-tasking skills

Staffs medically complex cases with the Supervisor of Case Management, designee, or Medical Director as directed.

Provides requested diagnosis/prognosis reports and stop loss reports that are received via Medical Management department requests.

Reviews high dollar pharmacy reports to identify appropriate referrals to Case Management or other Medical Management Services.

Assess and review current treatment history to identify appropriate referrals to Case Management Program or other Medical Management Services.

Consistently follows department Benefit Review policies and procedures to complete the review processes.

2+ years related experience required

Possess in-depth knowledge of recordkeeping and accounting system and have the ability to work with computer records

Strong understanding of custom and prototype plan provisions and apply this plan design knowledge to quality and reviews.

Good interpersonal, analytical, oral and written communication, organizational, problem solving and decision making skills

Skills That Will Help You Stand Out

Complete quality reviews on various roles within Client Onboarding and Deconversion Services (CODS)

Quality Care Office Registered Nurse (RN) with health insurance background or Care Manager experience and valid NJ RN License required

Strong critical thinking skills and ability to create subject/disease specific education

The Quality Care Registered Nurse will work collaboratively with AMG practices on population health initiatives and streamline education.

Advanced skills with Microsoft Office applications (Word, Excel, Access, Powerpoint)

Ability to manage multiple priorities and meet requested timelines

Strong communication skills, written/verbal essential

Please complete this application in entirety by providing all of your work experience, education and certifications/

You must meet all of the job requirements at the time of submitting the application.

Manages the necessary resources to implement and sustain the nursing quality & patient safety program congruent with organizational goals.

You can only apply one time to a job requisition.

Applications must be submitted prior to the close of the recruitment. Once recruitment has closed, applications will no longer be accepted.

Serves as a leading advocate for nursing quality & patient safety.

Experience with time management and organizational skills

Experience applying applicable CT statutes, regulations, policies, procedures, standards, codes requirements and best practices

MINIMUM QUALIFICATIONS - GENERAL EXPERIENCE

MINIMUM QUALIFICATIONS - SPECIAL EXPERIENCE

Comprehensive Benefits including Industry leading health benefits, including medical and dental coverage.

Extensive pension plan and supplemental retirement offerings.

Review and summarize client responses for senior management to measure client sentiment

Identify and report time-sensitive inbound client emails to senior management to ensure they are addressed promptly

Bachelor's degree or equivalent combination of education and experience

Learn and stay up to date with national and international regulatory requirements

You will work with managers to recognize and mitigate risk

Get a 360-degree view and gain invaluable insight into various departments by helping you gain exposure and prepare for future roles

Weiss Memorial Hospital is growing. We seek an Experienced Director of RN Quality Management.

2. 3-5 years of progressive clinical and management experience in health care

13. Maintains current knowledge of regulatory requirements and ensures that these are followed.

5. Excellent interpersonal skills with demonstrated mentoring and coaching capabilities

1. Develops the Patient Quality Plan in keeping with the Hospital’s quality mission and regulatory requirements.

3. Excellent analytical ability and strategic planning skills

Review and summarize client responses for senior management to measure client sentiment

Identify and report time-sensitive inbound client emails to senior management to ensure they are addressed promptly

Bachelor's degree or equivalent combination of education and experience

Learn and stay up to date with national and international regulatory requirements

You will work with managers to recognize and mitigate risk

Get a 360-degree view and gain invaluable insight into various departments by helping you gain exposure and prepare for future roles

Basic Education and/or Experience Requirements

Participate in own professional development by maintaining required competencies, identifying learning needs and seeking appropriate assistance or educational offerings.

Utilize computer programs to effectively collect, analyze, present, and communicate data to the staff, managers, and leaders.

Knowledge of pharmacovigilance processes and procedures per the FDA laws and regulations

Five (5) years of relevant clinical nursing experience in an acute care setting and /or home or ambulatory home infusion.

Able to manage multiple priorities and tasks efficiently and effectively

Experience with performance improvement methods, including statistical concepts and applications. preferred.

Strong organization and people skills, with a capacity for analyzing and presenting data.

Immune Effector Cellular Therapy Quality, RN

Self-directed and able to work independently.

Experience with utilization management systems or clinical decision-making tools such as: Medical Coverage Guidelines (MCG), CMS guidelines, and/or InterQual

Review all requests not approved by the non-clinical support rep to determine benefit coverage and medical necessity

At least two (2) years clinical experience

Excellent written and verbal communication skills

Experience working with multiple research/processing systems

Experience working with MS Word, Excel, and PowerPoint

This position is responsible for quality management/quality improvement activities with Care

Sandhills Center is a Local Management Entity-Managed Care Organization (LME-MCO) serving

Coordination/Case Management, Population Health, Community Relations, Pharmacy

3+ years of quality improvement or healthcare related experience

responsible experience in gathering, editing, and analyzing data or healthcare

and three years of experience as indicated above.

If you are relying on your education to meet qualification requirements:

Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).

Nurse I Level I - An Associate Degree (ADN) or Diploma in Nursing, with no additional nursing practice/experience required.

You will be evaluated for this job based on how well you meet the qualifications above.

IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE MAY NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE.

U.S. Citizenship; non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.