Position: Quality Review/ Management Senior RN
Company: Medix
Pay: $40
Address: Remote (has to be located in the state of CA)
Hours: M-F 8-4
Duration: Contract- hire with the initial contract lasting a minimum of 3 months
Required Licenses: RN-CA
Day to Day Responsibilities of this Position:
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Reviewing member complaints from a clinical standpoint
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Liaising with coordinators and providers on the team to request for pertinent medical records
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Synthesizing material and performing an accurate interpretation / case summary of medical records
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Managing a queue of cases and ensuring due dates are achieved
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Liaising with medical directors regarding clinical case reviews
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Participating in Peer Review Committee Meetings
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Liaising with the Lead RN and Manager of the department for day-to-day processes
Internal/External Groups with which the Candidate will interface with:
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Medical Director, Manager, Coordinators, Nurses
Required Skills:
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Registered Nurse 3 or more years
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Knowledge of health plans
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Quality and Risk Experience
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CPHQ certification
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Clinical nursing experience
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Knowledge of regulatory guidelines/ audits/ surveys
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Knowledge of computer programs and applications