Clinical QA Nurse Specialist

Vida Health

1d•$36 - $38•Remote

About The Position

Vida is seeking a licensed RN or LPN to manage clinical review requests, escalations, and member inquiries in a fully remote, virtual care setting. The role involves analyzing medical records, investigating concerns raised by members and internal teams, and guiding each case through resolution. The specialist also contributes to quality, safety, and process improvements across clinical operations. The position works with providers, Clinical Assistants, and cross-functional teams to support continuity of care and efficient resolution of member concerns. It includes maintaining accurate documentation, using provider messaging and telehealth systems, and performing duties within the applicable scope of practice and Vida clinical guidelines. Compensation is $36–$38 per hour.

Requirements

Active RN or LPN license in good standing.
At least 2 years of experience in primary care, family medicine, internal medicine, or an outpatient clinical setting.
Experience reviewing medical records and clinical documentation.
Strong written and verbal communication skills.
Excellent organizational skills and attention to detail.
Ability to analyze situations, identify issues, and implement appropriate solutions.
Ability to work independently and effectively in a fully remote environment.
Strong computer and technology proficiency.
Ability to use cloud-based technologies, including Slack, Google Workspace, Zendesk, Zoom, electronic medical records, and telehealth platforms.
Ability to navigate multiple systems simultaneously while maintaining accuracy and efficiency.
Ability to manage multiple priorities in a fast-paced setting.
Commitment to compassionate, patient-centered support.
Ability to adapt to evolving workflows, technology platforms, and operational processes.

Nice To Haves

Experience in a telehealth or virtual care environment.
Experience with utilization management, prior authorizations, or clinical review processes.
Experience supporting obesity medicine, chronic disease management, primary care, or population health programs.
Experience with quality assurance, compliance, clinical operations, or care coordination activities.
Familiarity with electronic prescribing systems and electronic medical records.

Responsibilities

Intake, triage, track, and respond to clinical review requests, escalations, and inquiries in accordance with established service level agreements.
Review and analyze patient medical records, extracting relevant clinical information for presentation to providers and leadership as needed.
Investigate and address clinical escalations from members and internal stakeholders, including Member Support, Account Management, and Clinical Operations.
Respond to member inquiries professionally and compassionately, following Vida clinical guidelines and program requirements.
Collaborate with providers, Clinical Assistants, and cross-functional teams to support continuity of care and resolve member concerns efficiently.
Monitor cases through resolution and ensure timely follow-up and documentation.
Support quality assurance initiatives by identifying trends, process improvement opportunities, and potential member safety concerns.
Assist with provider performance monitoring, quality reviews, and operational audits as assigned.
Maintain accurate, complete, and timely documentation within required systems.
Use provider messaging platforms, templates, workflows, and telehealth technologies efficiently and appropriately.
Perform duties within the scope of practice and in accordance with Vida clinical guidelines.
Perform additional responsibilities as needed.