Remote RN Clinical Quality Management Specialist ll (RN)

As an RN Clinical Quality Management (QM) Specialist II, you will work remotely in your home office from Monday to Friday, 8AM – 5PM Eastern Time and be responsible for supporting the Quality Management System and the activities of the Quality Improvement committees. This role involves supporting the Clinical Operations teams to ensure compliance with QMS and client contracts. The Clinical QM Specialist II identifies requirements and creates processes to ensure consistent and reliable execution of work. They coordinate the creation of controlled documents such as Standard Operating Procedures and Work Instructions, perform audits to meet performance metrics, and address internal and client concerns. Additionally, the Clinical QM Specialist II tracks and mitigates risks, facilitates continual improvement by leading improvement projects, and supports contract managers and the analytics team in preparing quality assurance reports.

*RN

*Quality Improvement

*Case Management within worker’s comp arena

*Must be a US Citizen to be considered

Responsibilities:

• Supports the Clinical Operations Team serving as a clinical resource for all program business units for quality assurance, clinical escalation and training.
• Performs clinical document reviews, identifies deficiencies, errors and collaborates with clinical professionals on remediation.
• Work with internal partners, such as Training, Program Management, Case Management, Analytics, and Information Technology, to bring creative solutions to meet corporate goals, and achieve client requirements.
• Work with external stakeholders and clients to ensure contract requirements and program quality management activities are successfully carried out.
• Collaborate with managers and teams regarding analysis, updates, and recommendations for modifications for procedures and processes to continually improve operations and protocols.
• Assist with the collection and summary of data in collaboration with Quality Committees, identify opportunities for improvement, and present findings.
• Understands each contract’s clinical quality assurance requirements and monitors compliance, in collaboration with the clinical leadership, analytics and management teams.
• Monitors and analyzes clinical outcomes in relation to goals and contractual requirements, in collaboration with the analytics and management team.
• Supports standard and ad hoc audits, as directed by clinical leadership quality committees.
• Provides feedback and coordination of improvement of quality tools, such as job aids, work instructions, and audit checklists.
• Assists in the identification of program deficits and coordinates team training and monitoring of corrective actions.
• Deploys and oversees performance improvement activities.
• Tracks client complaints and issues to resolution, in collaboration with Manager.
• Identifies new areas that need quality monitoring, on a short-term or continuous basis.
• Assists in activities to prioritize improvement initiatives.
• Assumes responsibility for related duties as required or assigned.

Qualifications:

• Registered Nurse, licensed in any state, with national certification in a relevant field
• 5 years related clinical experience with a minimum of two (2) years adult medical/surgical nursing experience and a minimum of two (2) years case management experience in the workers’ compensation arena OR have a minimum of one (1) year of adult medical/surgical nursing experience and three (3) years of case management experience in the workers’ compensation arena.
• At least 2 years’ experience with Quality Management including project management, quality improvement, corrective action, auditing, and/or staff education. Utilization Review. Medical Surgical.
• Experience with Federal Employee Compensation Act (FECA) and FECA-related issues preferable, as applicable.
• Nationally recognized Quality-related professional certification such as Certified Professional Healthcare Quality or Six Sigma (preferred).
• Bachelor’s or Master’s Degree preferred in Healthcare, Nursing, Health Administration, or a related field
• Experience with quality-related certification/accreditation such as ISO 9001-2015 Quality Management System or URAC.
• Experience in Workers’ Compensation, Disability Management, or related industrial health environment (preferred).
• National certification in case management or related field preferred in one of the following areas: Occupational Health (COHN); Case Management (CCM), Insurance Rehabilitation (CIRS/CRRN), Disability Management (CDMS), and/or Nurse Case Manager Board Certified (ANCC/ANA), preferred; or Nationally recognized Quality-related professional certification such as Certified Professional Healthcare Quality or Six Sigma, preferred
• Ability to pass a preliminary credit and background check

In addition to a competitive salary, comprehensive health and welfare benefits, tuition reimbursement, and incentive compensation, Company also offers participation and vesting in a 401(k) plan with a company match.

The information provided above has been designed to indicate the general nature and level of work of the position. It is not a comprehensive inventory of all duties, responsibilities, and qualifications required.

Successful candidates will be required to undergo a financial and criminal background check and obtain and maintain confidential-level security clearance upon hire.

Equal Opportunity and Affirmative Action Employer

All qualified applicants will receive consideration for employment without regard to age, citizenship status, color, disability, marital status, national origin, race, religion, sex, sexual orientation, gender identity, veteran status, or any other classification protected by federal state or local laws as appropriate, or upon the protected status of the person’s relatives, friends or associates.

Job Type: Full-time

Pay: $70,000.00 – $80,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Tuition reimbursement
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

Education:

• Bachelor’s (Preferred)

Experience:

• Case management (in Workers Comp): 2 years (Preferred)
• Workers’ compensation: 2 years (Preferred)
• FECA related issues: 2 years (Preferred)
• ISO 9001: 1 year (Preferred)
• Quality improvement: 2 years (Required)
• Quality audits: 2 years (Preferred)
• Clinical: 5 years (Preferred)
• Adult medical/surgical: 2 years (Preferred)
• Nursing: 5 years (Preferred)
• Utilization review: 2 years (Preferred)

License/Certification:

• RN License (Required)
• Six Sigma Green Belt (Preferred)

Work Location: Remote