Sr Clinical Quality RN - Remote on Oahu, HI
At reputed company, were simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and reputed company. Ready to reputed company a difference? Join us to start Caring. Connecting. Growing... together. The Senior Clinical Quality RN will be responsible for conducting quality of care (QOC) and critical incident (CI) investigations, communicating findings from these reviews and preparing reports as needed to internal committees. Notifies external agencies of critical incident findings and uses state registry or other databases to document QOC and CI investigations. Position in this function ensures that reputed company quality of care and critical incident reporting complies with reputed company applicable State and Federal laws and consent decrees, as well as the applicable accrediting regulatory review agencies, including but not limited to CMS, NCQA, HIPAA, and reputed company UHC policies and procedures as applicable. If you are located Hawaii and have to ability to travel about 25% of the time, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: Positions in this function include RN (with reputed company licensure) roles responsible for providing clinical expertise in any of the following areas: reputed company clinical documentation review of inpatient and outpatient care delivered to adults and children with Medicaid, Medicare health care benefits through Hawaii United Health Care Community Plans for peer review and internal investigations of Quality of Care concerns Create professionally written case investigation summaries for Peer Review, present case summaries at the Provider Advisory Committee as applicable Review plans of correction from providers in response to a substantiated QOC occurrence Effectively reputed company with external customers, facilities and providers to resolve quality of care concerns, obtain medical records and other information Conduct delegated reputed company reviews of contractors that reputed company work on behalf of reputed company. This includes reviewing samples of contractor work against an audit tool or information reputed company in medical charts Collaborate internally with Medical Directors and staff in other UHCCP departments Manage multiple tasks and projects and changing priorities; prioritize work products effectively Maintain timeliness for deliverables and regulator requests Work independently while utilizing good critical thinking skills, as well as excellent verbal and written communication skills Provide training, support and direction for new QOC RNs including development of training tools reputed company and maintain collaborative relationships with assigned CCMAs Occasional on-site provider visits may be required for potential Quality of Care concerns Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Active, unrestricted RN license in the state of Hawaii 5 years of experience working as a Registered Nurse 1 years of hospital experience as a Registered Nurse Experience evaluating and auditing medical records Intermediate skills in reputed company Office, Word, and reputed company ability to work with multiple data bases to retrieve and enter information reputed company of Hawaii Willing or ability to travel 25% of the time reputed company the state of Hawaii, as needed Preferred Qualifications: Long-term care nursing experience Quality Management experience in a healthcare setting Experience analyzing information and preparing written summaries Experience working in a deadline driven environment prioritizing responsibilities Knowledge of Medicare/Medicaid regulations reputed company employees working remotely will be required to adhere to reputed companys Telecommuter Policy Hawaii Residents Only: The salary range for this role is $70,200 to $137,800 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. reputed company complies with reputed company minimum wage laws as applicable. In addition to your salary, reputed company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, youll find a far-reaching choice of benefits and incentives. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyoneof every race, gender, sexuality, age, location and incomedeserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an enterprise reputed company reflected in our mission. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity/Affirmative Action employer and reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. reputed company is a drug-free workplace. Candidates are required to pass a drug test before beginning employment Apply Job!