• Clinical Quality Assurance Nurse

    Requisition ID
    2000-33
    # of Openings
    1
    Category
    Operations
    Location
    US-IL-Rockford
  • Overview

    Looking for a role that doesn’t require working nights, holidays or weekends? Looking to stay in the nursing world and utilize your clinical background? 

     

    We are seeking passionate and skilled LPN's and RN’s to serve as a Clinical Quality Assurance Nurse (internally known as Clinical QA Coordinator), reviewing cases and ensuring all necessary information has been provided and is accurate before sending back to requestor.

     

     

    Responsibilities

    ESSENTIAL DUTIES AND RESPONSIBILITIES TO PERFORM THIS JOB SUCCESSFULLY INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING:

    • Performs quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.
    • Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
    • Ensures that all client instructions and specifications have been followed and that all questions have been addressed.
    • Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.
    • Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
    • Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.
    • Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.
    • Ensures the provider credentials and signature are adhered to the final report.
    • Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.
    • Assists in resolution of customer complaints and quality assurance issues as needed.
    • Ensures all federal ERISA and/or state mandates are adhered to at all times.
    • Provides insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.
    • Promote effective and efficient utilization of company resources.
    • Participate in various educational and or training activities as required.
    • Perform other duties as assigned.

    Qualifications

    EDUCATION AND/OR EXPERIENCE 

    • RN or LPN License for IL required.

    QUALIFICATIONS 

    • Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
    •  Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages.
    • Must be a qualified typist with a minimum of 40 W.P.M
    • Must be able to operate a general computer, fax, copier, scanner, and telephone.
    • Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
    • Must possess excellent skills in English usage, grammar, punctuation and style.

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