Registered Nurse Provider Quality Review

Job Description
Work for a Community Centered healthcare organization!
Registered Nurse Job Description:
Reporting to the Manager of Provider Quality Oversight, the Provider Quality Review Nurse, RN is responsible for:

• Receive and research all PQI and QR cases as assigned, provide a summary and recommendations to the Medical Director of case assignments.
• Effectuate all action items as determined by the Medical Director to resolution of case assignments.
• Reviewing escalated issues
• Discussing and reviewing cases with Medical Directors referred to the Quality Management (QM) department.
• Investigation of cases includes, but not limited to, the documentation of case summaries, follow up actions, outreach efforts, and communications in the QM database.
  

Duties and Responsibilities

• Investigate and complete case summaries and make recommendations for any Potential Quality of Care Incidents (PQI) referred to the QM department.
• Maintain direct communication with all departments, external facilities including hospitals, Skilled Nursing Facilities, and/or Providers to ensure all PQI issues are thoroughly investigated, and care is coordinated in a timely manner, as needed.
• Review requested medical records to ensure complete case documentation is received from all practitioners, providers, and entities/agencies to ensure thorough investigation of the issue.
• Review case findings and recommendations with Medical Director. Issue Corrective Action Plans (CAP), review CAP responses, draft Opportunity for Improvement letters, and coordinate other interventions as needed to ensure all issues were addressed and future occurrences of the same issue are mitigated.
• Complete data entry into database systems, maintain updated documentation and other tracking mechanisms for all cases.
• Review and execute ad hoc requests, Quality Reviews, and/or focused audits, as needed.
• Escalate issues of non-compliance to the Quality Systems Management team.
• Maintain working knowledge of regulatory requirements as they relate to QM operations and protocols.
• Complete other tasks and assignments based on department and business needs.
• Demonstrate a commitment to incorporate LEAN principles into daily work.
  

Requires:
RN cleared to work and registered with the State of California
BS preferred
3 years relevant RN experience
Hours are Monday through Friday 8a-5p
This position requires onsite orientation and then will transition to a telecommute work environment.
*Only open to local applicants*
Looking forward to speaking with you!
Company Description
Cross Country Workforce Solutions Group (CCWSG) is a human resource, consulting and talent acquisition firm, specializing in PACE Programs, FQHCs/CHCs, and State Healthcare plans throughout the US. Our national operations center is located in Southern California.
CCWSG provides clinical and non-clinical staffing support to PACE centers across the country; we are the nation’s exclusive provider of non-medical, in-home caregivers for the elderly enrolled in PACE programs. Currently, we have over 2,600 caregivers supporting patients in their homes through PACE.
We are a part of the Cross Country Healthcare family, a market-leading workforce solutions, tech-enabled talent platform, and staffing, recruitment, and advisory firm with 37 years of industry experience and insight. We are a full-service partner, combining market expertise and services, including contingent staffing, consulting, human capital, management solutions, recruitment process outsourcing, vendor management, and direct hiring.
Cross Country Workforce Solutions Group (CCWSG) is a human resource, consulting and talent acquisition firm, specializing in PACE Programs, FQHCs/CHCs, and State Healthcare plans throughout the US. Our national operations center is located in Southern California. CCWSG provides clinical and non-clinical staffing support to PACE centers across the country; we are the nation’s exclusive provider of non-medical, in-home caregivers for the elderly enrolled in PACE programs. Currently, we have over 2,600 caregivers supporting patients in their homes through PACE. We are a part of the Cross Country Healthcare family, a market-leading workforce solutions, tech-enabled talent platform, and staffing, recruitment, and advisory firm with 37 years of industry experience and insight. We are a full-service partner, combining market expertise and services, including contingent staffing, consulting, human capital, management solutions, recruitment process outsourcing, vendor management, and direct hiring.