CareCentrix

  • Quality Review Nurse - Remote

    Job Locations Remote
    Job ID
    2018-6482
  • Overview

    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.

     

    PRIMARY RESPONSIBILITIES

     

    • 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

    • Assists in developing oversight tools and processes for clinical quality

    • Extracts data from systems and records and conducts quantitative and qualitative analysis of data & transformation into information that can be reported

    • Works with account/network management and/or Provider Services staff to ensure provider understanding and compliance with required elements of delegated functions

    • Work with clinical review staff to ensure compliance with delegated functions

    • 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
    • Completes designated audits, reports and analysis that require clinical expertise in regards to adherence with CareCentrix operational processes.
    • Audits care and individual cases as indicated to monitor and promote compliance with criteria and utilization guidelines, clinical operation policies and CareCentrix policies, works to track and trend results. Attends/participates in staff development programs and obtains continuing education as required by company policy and licensing bodies. Identifies self-development needs and initiates self-improvement
    • Participates in and contributes to performance improvement activities through clinical review of complex cases and coaching activities to expand and develop clinical skill for licensed associates.
    • Participates in implementing / maintaining operational processes to promote compliance with Company policies, legal requirements and regulatory mandates.
    • Reviews and adheres to all Company policies and procedures and the Employee Handbook.
    • Participates in special projects and performs other duties as assigned.

    Responsibilities

    ATTRIBUTES / QUALIFICATIONS
    This position requires excellent writing, organization and communication skills. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

     

    CORE REQUIREMENTS
    • Abides by and demonstrates the company Mission – Vision – Values through both behavior and job performance on a day-to-day basis.
    • Convey a strong professional image, exhibit interest and positive attitude toward all assigned work.
    • Adheres to and participates in Company’s mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices.

     

    PHYSICAL REQUIREMENTS
    • Must be able to remain in a stationary position 90% of the time.
    • Occasionally move about the office to access file cabinets, office machinery, etc.
    • Constantly operates a computer and other office productivity machinery (i.e., a calculator, copy machine, and computer printer).
    • Frequently communicates via phone and email. Must be able to exchange accurate information in these situations.
    • Occasionally lift items weighing up to 10 pounds.

    Qualifications

    • Minimum of an Associate’s degree with a current Registered Nurse license in the state(s) of practice without restrictions and a strong clinical background as an RN.  Bachelor's or Master's degree preferred.  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 be able to work effectively and collaboratively within a team – displays excellent interpersonal skills and assertive and diplomatic communication.
    • Must be able to work independently under general instructions, display initiative, be self-directed and motivated.
    • This position requires strong critical thinking/analytic skills, the ability to use data to drive improvement activities, and strong organizational and prioritization skills.
    • Must have excellent skills working with Microsoft Office applications such as Excel and PowerPoint and familiarity with navigating databases.

    We at CareCentrix know that our work matters and that we make a difference. We take pride in what we do and truly believe that our most valuable assets are our employees

     

    CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.

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