Clinical Quality Nurse

Job Description

The position is needed to ensure compliance with regulatory agencies ( DMHC) and health plans for PQI process and grievance TAT's. This extra nurse position is needed during the development and testing and initial implementation phases of a new single QI database for CA market. This position will be working with QI Coordinators, and Physician Reviewers for timely PQI reviews and grievance responses / case review and closing. The top 5-10 responsibilities for this position : Reviewing grievances and PQI cases, reviewing related medical records, drafting queries and overseeing case investigations, writing letters and assuring timely TAT's for responses to the health plans, creating case chronologies and reviewing with physician reviewers, preparing cases for 2nd reviewers and Peer Review meetings, Maintaining case investigation and closure process in the QI database.

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity / affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and / or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to .

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Required Skills & Experience

• CA LVN or RN license

Nice to Have Skills & Experience

Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and / or other paid time off as provided by applicable law.