Clinical Quality Nurse Jobs

Medical diagnoses, procedures, and acceptable treatment patterns. Inpatient hospital experience preferred.

Training and educational development for adult learners.

Plan, perform, and evaluate educational opportunities through a variety of means.

Utilization review, quality, and peer review processes/procedures.

And ability to utilize personal computer and corresponding applications including Microsoft Office (Word, Excel, Access, PowerPoint).

Organizing workload and preparation of correspondence for provider community and physician consultant reviewers.

Ongoing management of provider education on quality HEDIS measures

5+ years RN experience in performing UM, CM responsibilities working with the Medicaid population

Send monthly emails to providers notifying them that their latest PCOR is available to view and manage in Practice Assist

Developed provider education on the PPC and WCC measures in hopes to have better compliance in the future

3+ years of clinical nursing experience

Experience with presenting presentations and public speaking

Take ownership of patient experience via telephone:

2-5 years of relevant experience with a BSN degree OR:

5-8 years of relevant experience with an ASN degree OR:

How you’ll make a difference:

Notify respective management of "Red Flag Events", as noted within departmental documentation, caused by colleagues

Assist in creation and rollout of education and training materials for Credentialing Department needs

Excellent verbal and written communication skills

Expert level understanding of credentialing and licensure requirements

Intermediate knowledge of Microsoft Word, Outlook, Excel

Computer keyboard proficiency and internet navigation skills required