Quality Assurance Nurse
4 weeks ago
CorVel Healthcare Corporation is seeking a Quality Assurance Nurse to conduct utilization review and case management quality assurance audits. The ideal candidate will have experience in worker's compensation and a strong understanding of clinical and case management processes.
Key Responsibilities:
- Develop and implement quality assurance calibration processes to ensure compliance with organizational policies and procedures.
- Educate and equip operations with performance measurement and reporting tools to objectively measure and grow operations.
- Provide national account and regulatory quality oversight, including URAC compliance and renewals.
- Interface with utilization review managers to ensure compliance with organizational policies and procedures and URAC standards.
- Serve as a provider/client/vendor resource for utilization review and case management.
- Work with case management and utilization review department management to address CorVel standards, including quality assurance, reporting, and processes.
- Develop, run, and interpret management reports to ensure case management and utilization review operations are utilizing tools available to manage compliance with company standards.
- Facilitate peer-to-peer quality reviews to ensure delivery of quality case management and utilization review.
- Review results and outcomes with general management and case management leadership.
- Make recommendations in collaboration with field operations to ensure actions toward improvement are identified.
- Implementation, oversight, and communication of regulatory requirements within case management services, including state, federal, and URAC.
- Direct quality assurance audit activities and quality improvement plans in coordination with utilization management team managers to ensure compliance with state and URAC requirements.
- Conduct various types of case reviews for quality and appropriate medical management, cost containment, peer review, and rehabilitation.
- Identify trends and recommend action plans to management for continuous process improvement.
Requirements:
- Graduate of accredited school of nursing with a diploma/Associate degree (Bachelor of Science degree or Bachelor of Science in Nursing preferred)
- 3 or more years of recent clinical experience, preferably in rehabilitation
- National certification (CRC, CIRS, CCRN, CVE, CCM, etc.), CCM preferred
- Four-year degree at an accredited college or university preferred
- Certified Trainer and/or Quality Assurance distinction, a plus
- 4 years of utilization management experience; OR equivalent combination of training, education, and experience
Preferred Experience:
- Prior experience interacting with regulatory agency contacts, writing policies and procedures for URAC compliance, authoring state utilization review certification applications and renewals, and familiarity with legal and regulatory research related to workers' compensation utilization management laws, regulations, rules, and URAC standards interpretation.
Pay Range:
CorVel Healthcare Corporation uses a market-based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.
Pay Range: $56,860 – $91,580
A list of our benefit offerings can be found on our CorVel Healthcare Corporation website: CorVel Careers | Opportunities in Risk Management
About CorVel Healthcare Corporation:
CorVel Healthcare Corporation, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health, and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity, and Teamwork (ACE-IT).
A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.
CorVel Healthcare Corporation is an Equal Opportunity Employer, drug-free workplace, and complies with ADA regulations as applicable.
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