Clinical Quality Review Registered Nurse (RN) Remote for CA residents

Overview: Our client, a mutual benefit corporation and health plan provider, seeks an accomplished Clinical Quality Review Registered Nurse (RN).

Candidate must be authorized to work in USA without requiring sponsorship

* • ********************************************************************** • ** Location: 100% Remote for California Residents

• ** Duration: 9 months contract w/ possibility of extension or conversion to FTE role

Notes:

• 100% remote role for California residents.
• Work Hours: 8:00am - 4:30pm.

Description:

• The Clinical Quality Review (CQR) team investigates and reviews potential quality of care issue (PQI) allegations or concerns arising from member grievances and internal referrals. PQI reviews may confirm a quality problem that resulted in or had the potential for harm to the member and can lead to identification of provider opportunities for improvement related to practice patterns that are outside the framework of accepted standards.
• The Clinical Quality Reviewer, Nurse Experienced will report to the Manager, Clinical Quality Review.
• In this role, you will be responsible for reviewing PQI cases per department protocols through various levels of review and executing follow up actions.
• Analyze quality issues from both internal and external sources.
• Thoroughly investigate, apply critical thinking and clinical judgment to appropriately identify quality of care issues.
• Determine appropriate level of case review needed which may include escalating cases to a medical director, Peer Review Committee or Credentialing Committee to render a final determination.
• Prepare cases for presentation at physician committees as indicated.
• Prepare corrective action plan requests for cases where it is deemed necessary for the provider to institute a change in their present practice.
• Present and discuss corrective action plan responses with medical director and/or Peer Review Committee.
• Manage assigned case load to meet all timeliness metrics.
• May perform clinical oversight.

Qualifications:

• Associate’s or Bachelor’s degree in Nursing.
• California RN license.
• Organizational/computer skills/detail oriented.
• Health plan/IPA experience.
• Remote work experience.

Preferred Qualifications:

• Extensive clinical knowledge and experience, including in hospital setting.
• Previous quality review experience.
• Previous UM or CM experience.
• **********************************************************************

I'd love to talk to you if you think this position is right up your alley, and assure a prompt communication, whichever direction. If you're looking for rewarding employment and a company that puts its employees first, we'd like to work with you. Satwinder “Sat” Singh Lead Technical Recruiter Company Overview: Amerit Consulting is an extremely fast-growing staffing and consulting firm. Amerit Consulting was founded in 2002 to provide consulting, temporary staffing, direct hire, and payrolling services to Fortune 500 companies nationally, as well as small to mid-sized organizations on a local & regional level. Currently, Amerit has over 2,000 employees in 47 states. We develop and implement solutions that help our clients operate more efficiently, deliver greater customer satisfaction, and see a positive impact on their bottom line. We create value by bringing together the right people to achieve results. Our clients and employees say they choose to work with Amerit because of how we work with them - with service that exceeds their expectations and a personal commitment to their success. Our deep expertise in human capital management has fueled our expansion into direct hire placements, temporary staffing, contract placements, and additional staffing and consulting services that propel our clients’ businesses forward. Amerit Consulting provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. Applicants, with criminal histories, are considered in a manner that is consistent with local, state, and federal laws. Apply To this Job