Hybrid RN Clinical Quality Analyst - Quality & Risk

Optum; Worcester (MA); Hybrid; USD 60,000 - 107,000; Full time

Job summary

Reliant Medical Group, part of the Optum family, is seeking an RN Clinical Quality Analyst to participate in peer reviews, assess quality of care, and support performance improvement in a hybrid Worcester, MA setting. You will review case records, apply policies, and communicate findings to clinicians while collaborating with Risk & Quality Management to address system issues and ensure compliance.

This role requires Massachusetts RN licensure, 5+ years nursing experience, EMR familiarity, and

Qualifications

• Graduate from an accredited school of Nursing and current licensure as a Registered Nurse in Massachusetts.
• 5+ years nursing experience in a healthcare setting including hospital medical/surgical or ambulatory care.
• Experience utilizing electronic medical records.
• Knowledge of various software applications such as Microsoft PowerPoint, Excel, Access, Outlook.

Responsibilities

• Participates in the Peer Review Program by performing quality case reviews submitted by risk management, incident reports, audits, sentinel events, clinician referrals or any complaints related to quality of care.
• Utilizes critical thinking skills when interpreting and incorporating the organization’s policies and procedures to assess and evaluate case medical records, including chart review, provider feedback, and any previous reviews completed on the case to identify and address potential individual provider or operational process issues which impact the quality of care delivered at Reliant.
• Utilizes critical thinking skills to determine appropriate patient outcome and care ratings based on review findings and communicate the conclusions to providers.
• Participates with the development and correction of organizational system issue fixes to ensure compliance with legal and other external regulations/requirements to support the continuous performance improvement of the quality of care and service provided by the organization.

Skills

Critical thinking

Quality improvement

Provider feedback

Education

Massachusetts RN Licensure

Tools

Microsoft PowerPoint

Microsoft Excel

Microsoft Access

Microsoft Outlook

Job description

Reliant Medical Group, part of the Optum family, is seeking an RN Clinical Quality Analyst to participate in peer reviews, assess quality of care, and support performance improvement in a hybrid Worcester, MA setting. You will review case records, apply policies, and communicate findings to clinicians while collaborating with Risk & Quality Management to address system issues and ensure compliance.

This role requires Massachusetts RN licensure, 5+ years nursing experience, EMR familiarity, and