Quality Assurance Nurse

Please note: Must reside and be fully authorized to work in the US.  

**We are seeking remote applicants, preferably in Arizona, Texas, New Mexico, Nevada, or any state except California, Colorado, New Jersey, New York, and Washington.

Our Organization:

Welcome to Arkos Health! We are a value-based healthcare company providing solutions for payors and providers by combining unique technology with in-home, virtual, and in-clinical care for patients. Backed by a robust technology platform, innovative software, and a light human touch, Arkos Health is committed to delivering advanced and accessible community-based services allowing our clients to live healthier, more independent lives. How do we do this? Arkos serves health plans and provider organizations by managing their highest-risk and highest-cost populations. Our goal is to be the most valued partner to health plans, service providers, and the community we collectively serve.  

How You'll Make a Difference:

The Quality Assurance Nurse is responsible for auditing clinical and social needs assessments and care plans to ensure state, federal, health plan, CMS, NCQA, and URAC requirements are met, as applicable. The Quality Assurance Nurse will also ensure all internal Arkos processes and procedures are followed during the members care management journey. 

Essential Duties and Responsibilities:

• Responsible for auditing care management documentation including clinical and social assessments and care plans
• Ensure all state, federal, health plan, and accreditation entity requirements and guidelines are followed specific to the applicable market, plan, and line of business
• Identify any productivity, efficacy, process improvement or training opportunities for clinical services teams
• Communicate auditing results for training and quality improvement opportunities to appropriate leadership through weekly reporting of identified areas of concern
• Prepare and appropriately deliver audit results monthly to QA Director
• Provide coaching, mentoring, and education to teams related to clinical programs, policies, and processes
• Work closely with all markets leadership teams to achieve high quality performance for all care management and social services functions
• Prepare and present audit results and improvement tactics to achieve high performance
  
• Reviews for appropriate clinical decision-making and provide feedback to the Clinical Services teams regarding evidence-based best practices as needed

Qualifications and Skills:

• Current, unrestricted Nursing license.
  
• Ability to present clinical information both accurately and confidently with all levels of internal staff and external customers
• Working knowledge of NCQA and URAC standards
  
• Knowledge of Medicare, Medicaid, and local managed care regulations, prior experience in Managed Care setting preferred

Benefits:

• Employer-paid Medical premiums at no cost to you
• Employer-paid Dental premiums at no cost to you
• Employer-paid Vision premiums at no cost to you
• Employer-paid Short-Term Disability premiums at no cost to you
• Employer-paid Life Insurance premiums at no cost to you
• Employer matching 401(k)
• 15 days annual combined sick/vacation and 9 days of holiday during your first year
• Your Birthday off!

Must complete our Culture Index Survey. Take the assessment at https://go.cultureindex.com/s/bg3VS0H2kF.   This is not a pass/fail test and does not measure intelligence.

Arkos Health EEO Statement:

We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.

Arkos Health is a drug-free workplace. All job applicants selected for employment are required to submit to a pre-employment drug test and background check.