RN, QI Nurse - Remote

Lensa - El Segundo, CA

Job Title: RN, QI Nurse - Remote

Position: Quality Improvement Nurse

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 & 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, unrestricted California RN license
2+ years of clinical experience in an IPA, medical group, hospital, or health plan setting
Proficient with Microsoft Word, Excel, and PowerPoint

Experience: 2+ years of clinical experience

Education: BSN or equivalent is preferred

License & Certification:

Schedule:

COVID-19 Requirements: Not Specified

OptumCare is an Equal Employment Opportunity employer and does not discriminate based on race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status.
OptumCare is a drug-free workplace; candidates are required to pass a drug test before beginning employment.