Quality Review Nurse

1 week ago


Phoenix, United States Center for Orthopedic and Research Excel Full time
Job DescriptionJob Description

For Value-Based Care (VBC) programs within HOPCo Clinically Integrated Networks (CINs), promotes adherence to evidence-based best practices and quality assurance standards by conducting chart audits. Collaborates with physicians, patient/family, and VBC team members to assure patient management to efficiently align patient needs using resources to meet quality, clinical, and cost-effective outcomes within the CIN.

Benefits:

  • Salary $28-38.00/hr DOE
  • Competitive Health & Welfare Benefits
  • HSA with qualifying HDHP plans with company match
  • 401k plan after 6 months of service with company match (Part-time employees included)
  • Employee Assistance Program that is available 24/7 to provide support
  • Employee Appreciation Days
  • Employee Wellness Events


ESSENTIAL FUNCTIONS

  • Audit and analyze patient records to ensure adherence to clinical practices and protocols and appropriateness of services
  • Provide reports on results obtained from audits and analysis to identify opportunities for improvement
  • Investigate, analyze, and report questionable findings along with recommendations, to assist in identifying gaps in quality patient care
  • Monitor the factors and trends that influence physician and network performance
  • Support the Value-Based Care CMO and VBC team in enhancing Excellence Through Evidence-Based best practice program
  • Complete all reporting requirements on time with data integrity, and in the requested format to ensure appropriate documentation
  • Accept, receive, and manage Care Management referrals, who meet criteria, in a timely manner
  • Collaborate with patients, families, physicians, and other healthcare team members in building consensus around issues and appropriately resolve promptly
  • Provide education and coaching for specific population needs as required by the VBC Care Management program
  • Communicate effectively and professionally with internal and external customers
  • Ensure the patient is progressing toward desired outcomes by monitoring patient care through assessment and evaluation
  • Ability to assess current operations, policies, systems, and procedures to develop and implement necessary and innovative changes
  • Ability to manage protected health information (PHI) in a manner consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
  • Perform related duties as assigned
  • Perform other CIN duties as assigned

EXPERIENCE

  • Licensed Registered Nurse (RN) required
  • Bachelor’s degree in nursing preferred
  • Minimum three (3) years of clinical nursing and/or Care Management experience is required
  • Orthopedic experience required.
  • Clinical review, utilization review, or quality assurance review experience preferred


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