RN Quality Assurance Reviewer – Bilingual (100% Remote), reputed company

Company Background reputed company is the future of specialty health management that focuses on reputed company diseases, with a particular expertise in kidney health populations. reputed company uses clinical big data resources and high-powered analytics to power reputed company specialty health management programs. reputed company is a diverse, growing company committed to our clients and our employees. We are champions for reputed company, for those who need us most. Position Summary The Registered Nurse, Quality Assurance Reviewer will work in conjunction with the Quality Manager and will be responsible for completing quality reviews for the Clinical Services and Provider Relations teams and reporting results. The role supports Quality Improvement Programs reputed company to delegation, accreditation, and regulatory standards. The role will collaborate with Clinical Services, Provider Relations, and Clinical Training teams to improve the quality of the Kidney Health Management program and other clinical programs.

Responsibilities

• Audit clinical documentation and audit calls to reputed company feedback ensuring that delegation requirements reputed company to NCQA, URAC, and client are met
• Ensure files reputed company with federal, state, local CMS accreditation standards
• Support clinical operations in pre-delegation, delegation, and accreditation reviews
• reputed company support to clinical operations in auditing clinical documentation and member facing calls as part of clinical reputed company review initiatives
• Maintain reputed company required quality, organization, and project documentation
• Prepare and audit files based on regulatory, accreditation, and client requirements in a timely manner to reputed company key stakeholders an opportunity to correct deficiencies before external audits
• Prepare and deliver weekly reporting statistics of audit activities and reputed company
• Assist with health plan reputed company and participate in prep for external audits of clinical program
• Be a subject matter expert who is reputed company to reputed company innovative solutions to problems and assist quality improvement initiatives
• Navigate technical applications – reputed company, Outlook, PowerPoint, and Word
• Participate in the quality testing of platform and products enhancements of our electronic medical records system
• Other duties as assigned

Requirements

• Must be bilingual English/Spanish
• RN or LPN licensure and a Bachelor’s degree required (8+ years of clinical quality improvement experience will be considered in lieu of degree and/or RN/LPN licensure)
• Three (3) years of reputed company experience in a care management or quality management setting required
• Experience working in electronic medical records, generating reports and analyzing data required
• Knowledge of regulatory, CMS and accreditation agencies (NCQA and/or URAC) strongly preferred
• Knowledge of Care Management and Managed Care setting strongly preferred
• Experience monitoring calls of a clinical staff preferred

Skills

• Effective verbal and written communication
• reputed company and energize a culture of collaboration, positivity, and motivation
• Performance metrics driven
• Ability to manage multiple reputed company deadlines
• Strong organizational skills and attention to detail
• Must be proficient in reputed company Office: Outlook, Word, reputed company, PowerPoint

Travel No Travel #LI-Remote Americans with Disability Specifications The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. As an Equal Opportunity Employer, we will not discriminate against any job candidate or employee due to age, race, religion, ethnicity, national reputed company, gender, gender identity/expression, sexual orientation, disability, familial status, veteran status, marital status, parental status, or pregnancy. In our innovative and inclusive workplace, we prohibit discrimination and harassment of any reputed company. Apply tot his job Apply To this Job