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POSITION SUMMARY:
The Clinical Quality Assurance Nurse reviews cases and ensures all necessary information has been provided and is accurate before sending back to requestor. The Clinical Quality Assurance Nurse will also oversee the facilitys policies and procedures.
RESPONSIBILITIES/ACCOUNTABILITIES:
Performs quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.
Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
Ensures that all client instructions and specifications have been followed and that all questions have been addressed.
Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.
Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.
Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.
Ensures the provider credentials and signature are adhered to the final report.
Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.
Assists in resolution of customer complaints and quality assurance issues as needed.
Ensures all federal ERISA and/or state mandates are adhered to at all times.
Provides insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.
Promote effective and efficient utilization of company resources.
Participate in various educational and or training activities as required.
Perform other duties as assigned.
QUALIFICATIONS/SKILLS:
LVN License required.
Must be able to operate a general computer, fax, copier, scanner, and telephone.
Full Time
$81k-95k (estimate)
05/03/2024
05/18/2024
riversidepostacute.com
Jurupa Valley, CA
<25
The following is the career advancement route for Quality Assurance Nurse positions, which can be used as a reference in future career path planning. As a Quality Assurance Nurse, it can be promoted into senior positions as a Quality Assurance Coordinator - Healthcare that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Quality Assurance Nurse. You can explore the career advancement for a Quality Assurance Nurse below and select your interested title to get hiring information.