Remote Nurse RN: Quality Review Specialist

TALENT Software Services; California (MO); Remote; USD 80,000 - 105,000; Full time

Job summary

TALENT Software Services is seeking a Clinical Quality Reviewer to join our CA-based remote team. You will review PQI allegations and coordinate multi-level reviews, applying clinical judgment to determine escalation paths and final determinations.

Responsibilities include analyzing quality issues from internal and external sources, preparing cases for physician committees, and developing corrective action plans. Strong communication and timeliness are essential.

Qualifications

• Nursing degree (Associate or Bachelor's).
• CA RN license (current and unencumbered).

Responsibilities

• Analyze quality issues from both internal and external sources
• Thoroughly investigate, apply clinical judgment to identify quality of care issues
• Determine appropriate level of case review including escalation to medical director or committees
• Prepare cases for presentation at physician committees as indicated
• Prepare corrective action plan requests for cases requiring changes in practice
• Present and discuss corrective action plan responses with medical director/committee
• Manage assigned case load to meet timeliness metrics
• May perform clinical oversight

Skills

Organizational skills

Health plan/IPA experience

Clinical knowledge

Education

Associate's or Bachelor's degree in Nursing

Tools

Microsoft Office

Excel

Adobe Acrobat

Job description

TALENT Software Services is seeking a Clinical Quality Reviewer to join our CA-based remote team. You will review PQI allegations and coordinate multi-level reviews, applying clinical judgment to determine escalation paths and final determinations.

Responsibilities include analyzing quality issues from internal and external sources, preparing cases for physician committees, and developing corrective action plans. Strong communication and timeliness are essential.