Quality Management Nurse

Medasource; Chicago (IL); Remote; USD 55,000 - 99,000; Full time

Job summary

Medasource is seeking a Remote Registered Nurse (RN) Case Manager to manage workload and quality of care cases. The ideal candidate will possess an active RN license in Arizona and have experience in quality management, ensuring member care needs are effectively met. The position allows for remote work, with a focus on investigation and implementation of healthcare quality standards.

Benefits

Vision insurance

Medical insurance

Qualifications

• Two years of clinical experience in an acute care or outpatient setting.
• Experience with incident reports and strong healthcare regulations knowledge.
• Ability to analyze charts and identify healthcare concerns.

Responsibilities

• Investigates referred Quality of Care concerns and prepares cases for review.
• Assists in developing the organization-wide Quality of Care training program.
• Communicates monitoring process results to relevant directors and supervisors.

Skills

Quality Management

Healthcare Knowledge

Risk Management

Data Analysis

Education

Active RN License (Arizona or Compact)

CPHQ Certification

Certified Case Manager (CCM)

Job description

Reason for opening: Influx of workload and cases coming in.

Start Date: 7/7

Contract: 6 month contract w/ strong possibility for extension/conversion (CTH only if they reside in AZ)

Hard Requirements:

• Active RN license in the state of Arizona (compact license also acceptable)
• Two years of clinical experience in an acute care or outpatient setting; Prefer at least one year of experience working in a quality management role in an outpatient or inpatient setting and strong healthcare knowledge is also required.
• Ability to analyze charts- to identify concerns, determine if they occurred, and understand member outcome
• Experience with incident reports/sentinel events- experience with investigating these types of events either from a hospital or similar setting.
• Experience working with clinicians inside and outside their scope
• Demonstrated knowledge of quality management principles, healthcare regulations, and evidence-based practice

Certifications (Preferred/Required):

• Required: Active RN License (AZ or Compact)
• Preferred (any of the following):
• CPHQ – Certified Professional in Healthcare Quality
• Certified Case Manager (CCM) or equivalent quality/care management credential

Location/Work Parameters:

• Fully Remote- AZ highly preferred (required for conversion)
• Okay with PST, MST, and CST time zones
• Can start between 730-930am AZ time.

Metrics:

• Ideally 1-2 Cases daily with a target closure of 30-60 days.

Responsibilities:

1. Investigates referred Quality of Care concerns, including medical record documentation review, obtaining provider/facility responses, preparation of acknowledgment and closure correspondence, tracking cases in database.

• Systemic investigation review of providers and facilities requires obtaining and reviewing multiple member records, requesting provider/facility responses, preparing necessary letters, and tracking on the appropriate tracking tool.

2. Prepares Quality of Care cases and presents cases to Medical Director for review.

3. Assists in the development and implementation of the Organization-wide Quality of Care training program.

4. Communicates the results of the monitoring and evaluation process to QOC Medical Director, MM and Clinical Quality of Care (CQOC) Director, Senior Manager, and CQOC Supervisor.

5. Identifies potential Risk Management, FWA, and Compliance issues during process of quality investigation and refers to appropriate staff/departments.

6. This position makes decisions which facilitate smooth coordination of care to ensure member’s care needs are met while maintaining quality standards in a financially responsible manner. Clinical Reviewers perform independently.

Seniority level

• Seniority level

  Associate

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

Referrals increase your chances of interviewing at Medasource by 2x

Inferred from the description for this job

Vision insurance

Medical insurance

Get notified about new Nurse jobs in Arizona, United States.

Remote Registered Nurse (RN) Case Manager

Remote Registered Nurse (RN) Case Manager

Utilization Review RN (Remote in Arizona)

Arizona, United States $55,100 - $99,000 1 week ago

Triage Nurse I – Carebridge, Multiple Locations

Arizona, United States $26.41 - $96.15 1 week ago

Arizona, United States $55,100 - $99,000 2 weeks ago

Associate Director, RN Medical Management Services

Arizona, United States $70,000 - $75,000 1 week ago

Sr. Specialist, Quality Program Management & Performance RN (RN Required, BSN Preferred, must reside in AZ)

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.