Clinical Quality Investigator - Nursing

MCS Health; San Juan (PR); On-site; USD 55,000 - 75,000; Full time

Job summary

MCS Health in Puerto Rico seeks a qualified nurse to manage grievance and quality-of-care investigations. You will review cases, coordinate actions with clinical teams, and ensure proper documentation and follow-up with providers and facilities.

The role requires a BSN and at least two years of clinical experience, a valid Puerto Rico nursing license, and strong English proficiency. Spanish fluency is an asset for this position.

Qualifications

• BSN degree with at least two years of clinical experience.
• Nursing license and Puerto Rico registration.
• Excellent English oral and written proficiency.
• Spanish Advanced; English Intermediate.

Responsibilities

• Receives and reviews cases referred by Grievance and Appeal Unit and other MCS departments; identifies GMP Providers/Administrators for orientation or evaluation.
• Develops a weekly work plan with coordinated individual case discussions.
• Liaises between Quality Department and Clinical Affairs, Grievance and Appeal units to review and analyze complaints and quality-of-care issues.
• Informs the Grievance and Appeal Unit of required files and documentation; ensures continuity until case closure.
• Conducts nursing-level case file evaluations and documents progress in electronic systems within set timeframes; collaborates with the reviewing physician to develop action plans.
• Investigates and coordinates clinical review of files to analyze complaints.
• Notifies Providers/Facility Administrators of results and requests action plans as needed.
• Participates in Clinical Quality Management Peer Review Committee meetings and Quality Department meetings; presents cases with trends.
• Discusses complaints and corrective action plans with providers; follows up to ensure implementation of actions.
• Executes evaluation and follow-up of CAPs related to HACs; conducts onsite and virtual meetings with hospital quality staff and presents findings.
• Prepares reports on complaints/grievances and action plans for management.

Skills

English proficiency

Spanish proficiency

Education

Bachelor of Science in Nursing

Job description

MCS Health in Puerto Rico seeks a qualified nurse to manage grievance and quality-of-care investigations. You will review cases, coordinate actions with clinical teams, and ensure proper documentation and follow-up with providers and facilities.

The role requires a BSN and at least two years of clinical experience, a valid Puerto Rico nursing license, and strong English proficiency. Spanish fluency is an asset for this position.