Remote Clinical QA Nurse Specialist

Vida Health; United States; Remote; USD 50,000 - 52,000; Full time

Job summary

Vida Health is seeking a licensed RN or LPN to manage clinical review requests, escalations, and member inquiries in a fully remote, virtual care setting. You’ll analyze medical records, extract key clinical information, and drive cases to resolution while upholding Vida’s guidelines.

The role emphasizes collaboration with Providers and cross-functional teams, with a focus on quality, safety, and process improvements across clinical operations in a telehealth environment.

Qualifications

• Active RN or LPN license in good standing.
• Minimum of 2 years of experience in a primary care, family medicine, internal medicine, or outpatient clinical setting.
• Experience reviewing medical records and clinical documentation.
• Strong written and verbal communication skills.
• Excellent organizational skills and attention to detail.
• Proven ability to analyze situations, identify issues, and implement appropriate solutions.
• Ability to work independently and effectively in a fully remote environment.

Responsibilities

• Intake, triage, track, and respond to clinical review requests, escalations, and inquiries in accordance with established SLAs.
• Review and analyze patient medical records, extracting relevant clinical information for presentation to providers and leadership as needed.
• Investigate and address clinical escalations originating from members, Member Support, Account Management, Clinical Operations, and other internal stakeholders.
• Respond to member inquiries professionally, compassionately, and in accordance with Vida clinical guidelines and program requirements.
• Collaborate closely with Providers, Clinical Assistants, and cross-functional teams to support continuity of care and efficient resolution of member concerns.
• Monitor cases through resolution and ensure timely follow-up and documentation.
• Support quality assurance initiatives by identifying trends, process improvement opportunities, and potential member safety concerns.
• Assist with provider performance monitoring, quality reviews, and operational audits as assigned.
• Maintain accurate, complete, and timely documentation within all required systems.
• Utilize provider messaging platforms, templates, workflows, and telehealth technologies efficiently and appropriately.
• Perform all duties within the scope of practice and in accordance with Vida clinical guidelines.
• Additional responsibilities as needed.

Skills

RN/LPN license

2+ years clinical experience

Education

RN or LPN license

Job description

Vida Health is seeking a licensed RN or LPN to manage clinical review requests, escalations, and member inquiries in a fully remote, virtual care setting. You’ll analyze medical records, extract key clinical information, and drive cases to resolution while upholding Vida’s guidelines.

The role emphasizes collaboration with Providers and cross-functional teams, with a focus on quality, safety, and process improvements across clinical operations in a telehealth environment.