RN, QI Nurse - Remote

Lensa - El Segundo, CA

Job Title: RN, QI Nurse - Remote

Position: Clinical Grievance RN

Job Type: Full Time

Pay: $28.61 to $56.06 per hour

Shift: Pacific Standard Time (PST)

Work Type: Remote

Address:

City: El Segundo

State: CA

ZIP Code:

Review health plan grievances and assign an appropriate severity level and issue code.
Create written documentation of quality of care findings, using effective clinical judgment.
Ensure appropriate resolution of member grievances in a timely and appropriate manner.
Identify non-compliance with state, federal, and Health Plan standards when investigating appeals and grievances, and intervene as indicated.
Work with Network Management staff to ensure provider understanding and compliance with required elements of medical record documentation and other clinical practice standards.
Assist in the Quality Medical Director review process by gathering pertinent medical information, presenting the cases, and coordinating interventions as advised by the Medical Director/Peer Review Committee.
Assist in the Quality Peer Review process by gathering information for physician peer reviewers.
Track and trend incidents of service and clinical quality of care issues and identify opportunities for improvement.
Coordinate case reviews with the QI coordinator.

Current and valid California RN license
2+ years of clinical experience with an IPA, medical group, hospital, or health plan setting
Proficient with Microsoft Word, Excel and PowerPoint
Ability to work Pacific Standard Time (PST) hours

Experience: 2+ years of clinical experience with an IPA, medical group, hospital, or health plan setting

Education:

License & Certification:

Schedule:

COVID-19 Requirements: Not Specified

OptumCare is an Equal Employment Opportunity employer under applicable law.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.