RN - Quality of care Investigative Nurse

Talent Software Services, Inc.; Phoenix (AZ); Hybrid; USD 65,000 - 85,000; Full time

Job summary

TALENT Software Services seeks a Registered Nurse to perform quality-of-care investigations within our Quality Management Unit. The role requires collecting documentation, reviewing medical charts, and applying standardized corrective actions to cases that impact member health.

Work is 40 hours weekly with an in-person start for equipment and training, followed by remote onboarding. Ideal candidates hold an active RN license and excel in reporting and regulatory coordination.

Qualifications

• Active RN license in the appropriate jurisdiction.
• Experience in quality-of-care investigations preferred.
• Strong documentation and regulatory knowledge.

Responsibilities

• Conduct timely and thorough investigations of all quality-of-care issues.
• Implement vendor-specific corrective action plans using a standardized process.
• Make referrals to oversight and regulatory agencies when required.
• Maintain comprehensive documentation for each case work file.
• Elevate cases and trend concerns to supervisors as needed.

Skills

Critical thinking

Tech proficiency

Report writing

Research & analysis

Communication

Organization

Medical chart review

Nursing process

Decision making

Problem solving

Education

RN license

Job description

Schedule

The first day requires in-person attendance for equipment collection and completion of necessary security training to access systems. Subsequent onboarding and training will be conducted remotely. The work schedule is 8am-5pm, Monday through Friday, totaling 40 hours per week.

This position is part of the Quality Management Unit and involves conducting quality-of-care investigations in accordance with relevant contracts and regulations. The role focuses on both member-centric and systemic quality concerns to ensure the health and well-being of members.

Responsibilities include conducting timely and thorough investigations of all quality-of-care issues and implementing vendor-specific corrective action plans using a standardized process. The role involves making appropriate referrals to oversight and regulatory agencies, participating in various member-related concerns and issues, and maintaining comprehensive documentation for case work.

The position requires requesting and maintaining necessary documentation for investigations and ensuring all relevant information is uploaded to the appropriate portal. The role also involves elevating cases and trend concerns to supervisors as needed.

Skills

• Critical thinking
• Technological proficiency, including databases, Microsoft Office, email, and electronic resources
• Ability to produce professional technical reports and letters
• Research and analysis skills
• Strong oral and written communication skills
• Personal planning, organization, and time management
• Medical chart review
• Proficiency in the nursing process, including assessment, monitoring, and evaluation
• Decision-making skills
• Ability to critically analyze problems and develop effective corrective action plans

Required Education

Registered Nurse (RN) license in the appropriate jurisdiction.