RN Clinical Quality Reviewer

Legacy Health; Portland (OR); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare organization is seeking an RN Clinical Quality Reviewer to ensure the integrity of the clinical review process and enhance healthcare services quality. Ideal candidates will have a strong nursing background with at least 5 years of relevant experience and a commitment to quality improvement. This remote position requires proficiency in healthcare regulations and a passion for patient care.

Qualifications

• Minimum of 5 years in clinical data abstraction or related.
• Experience with chart review and quality assurance preferred.

Responsibilities

• Review and evaluate quality of patient care and compliance with regulations.
• Monitor evidence-based practices related to CMS requirements.

Skills

Chart review processes

Healthcare quality standards

Communication skills

Coordination abilities

Education

Bachelor's degree in nursing

Master's degree in Nursing or related

Job description

Overview

Remote Position (OR/WA Only)

This is a remote position – incumbents, who reside in Oregon or Washington only. There may be occasional situations that require work to be performed on-site at an assigned Legacy Health location. All new hires are required to come to a designated Legacy Health office location in Portland, Oregon prior to their start date for a new hire health assessment and to complete new hire paperwork.This position may require initial training and orientation to be site-based, before transitioning to the remote schedule.

Responsibilities

At Legacy, our mission is to make life better for our patients, our staff, and the community. As part of that mission, we are committed to continually reviewing and enhancing the quality of our services, always looking for ways to build on our strengths.

If you thrive in quality and performance improvement and share our passion for helping others, you may be an ideal fit for this position.

The RN Clinical Quality Reviewer plays a pivotal role in ensuring the integrity of clinical review process for quality of patient care processes while enhancing the overall quality of healthcare services provided by the organization. This position provides clinical nursing knowledge and is tasked with reviewing and evaluating the quality of patient care, assessing compliance with healthcare regulations and standards, and facilitating standard review and responses to internal and external quality of care inquiries

Additionally, the RN Clinical Quality Reviewer serves as the primary monitor of evidence based clinical practice related to CMS regulatory requirements. Responsibilities include performing standard secondary review for safety events, patient grievances and for external inquiries from commercial and government payors; drafting and submitting responses to internal and external inquiries regarding quality of care.

Qualifications

Education:

• Bachelor’s degree in nursing required.
• Master's degree in Nursing, Healthcare Management, Public Health, or a related discipline preferred.

Experience:

• Minimum of 5 years of experience in clinical data abstraction and/or related field required.
• Demonstrated experience with chart review required.
• Previous experience providing in quality preferred.

Skills:

• Advanced expertise in chart review processes and healthcare quality standards.
• Excellent coordination and communication abilities to ensure compliance and facilitate timely responses to inquiries.
• Proficiency in CMS requirements, TJC eCQand similar regulatory requirements
• Strong communication skills to support evidence-based practice.

Licensure

• Registered Nurse (RN) license required.
• Certification in healthcare quality (e.g., CPHQ) or related certifications preferred.

Pay Range

USD $48.91 - USD $72.88 /Hr.

Our Commitment to Health and Equal Opportunity

Our Legacy is good for health for Our People, Our Patients, Our Communities, Our World. Above all, we will do the right thing.

If you are passionate about our mission and believe you can contribute to our team, we encourage you to apply—even if you don't meet every qualification listed. We are committed to fostering an inclusive environment where everyone can grow and succeed.

Legacy Health is an equal opportunity employer and prohibits unlawful discrimination and harassment of any type and affords equal employment opportunities to employees and applicants without regard to race, color, religion or creed, citizenship status, sex, sexual orientation, gender identity, pregnancy, age, national origin, disability status, genetic information, veteran status, or any other characteristic protected by law.