Remote Quality Analyst/Clinical Nurse Advisor (RN)

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. Our company optimizes the entire member/patient experience through service offerings for clinical operations, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Colorado-based Sagility has more than 30,000 employees across 5 countries and revenues of over $500 million.

The Sagility team is currently hiring Quality Analyst/Clinical Nurse Advisor. In this role you will monitor, report on and coach behaviors to ensure quality standards are met and develop initiatives designed to improve quality performance.

Key Requirements:

• Responsible for monitoring in an objective fashion of all customer contact points. (Web, voice, e-mail, white mail)
• Responsible for reporting all behavior that does not conform to the quality standards set by the company and the account management.
• Designs and implements reports to establish patterns and trends of quality issues as they may arise.
• Provides quantifiable data for all quality judgments that are made.
• Works with Operations and other Support Groups as an auditor as well as regulator of quality issues.
• Provides coaching tips and materials to Operations to enhance product knowledge, system navigation and soft skills.
• Works with Operations and Support Groups to provide trend reports to address any issues.
• Works with Operations and Support Groups to develop initiatives designed to improve quality performance.
• Conducts Calibration Sessions with the client and with Operations.
• Conducts product specific coaching sessions with the agents regarding trends and quality.
• Provides updated, accurate and timely reports as required to the Quality Lead/Manager.
• Offers suggestions for continuous improvement of process and systems.
• Actively assist in maintaining operational excellence on critical metrics such as service levels.
• Render phone time as required/scheduled and when needed to help with Operations’ service levels, call volume, etc.).
• Performs Utilization Management review similar to Clinical Nurse Advisors in accordance to federal and state mandated regulations, HUM URAC standards and client requirement and/or policies as needed.
• Follows other tasks and/or offline tasks assigned by the Quality Lead/Manager.

Education, Experience, and Skills:

• Active unrestricted PHRN and US Licensed Registered Nurse (USRN)
• Active PHRN and US Certified Registered Nurse (USRN) license, state license requirements, CEUs and state mandate requirements.
• 2-3 years of post-education clinical experience
• 2-3 years of post-education clinical experience

Join our team, we look forward to talking with you!

An Equal Opportunity Employer/Vet/Disability

Job Type: Full-time

Experience:

• Nursing: 1 year (Preferred)

License/Certification:

• BLS Certification (Preferred)
• RN (Preferred)

Work Location: Remote