Quality Assurance Nurse

CorVel Corporation•Folsom, CA

3d•$61,053 - $98,334•Remote

About The Position

The Quality Assurance Nurse is responsible for case management quality assurance and mentorship of operations staff, providing tools and calibrating processes, while ensuring consistent delivery of CorVel’s case management services. This is a remote position.

Requirements

Excellent oral and written communication skills
PC literate, including Microsoft Office (Word, Excel)
Strong knowledge of clinical and case management processes
Strong knowledge and experience in quality assurance and training programs
Proficient in identifying case management office improvement opportunities and communicating and implementing solutions
Ability to remain poised in stressful situations and communicate using diplomacy
Ability to manage multiple complex projects and competing priorities while working under pressure to meet deadlines and maintaining strong customer service orientation
Effective quantitative and analytical skills
Must have strong organizational skills
Ability to work independently or in a team environment while functioning as an educator rather than an auditor
Knowledge of the entire claims administration, case management and cost containment solution as applicable to third party administrator operations
Graduate of accredited school of nursing with a diploma/Associates degree (Bachelor of Science degree or Bachelor of Science in Nursing preferred)
3 or more years of recent clinical experience, preferably in rehabilitation
National certification (CRC, CIRS, CCRN, CVE, CCM, etc.), CCM preferred
Four year degree from an accredited college or university preferred
Certified Trainer and/or Quality Assurance distinction preferred
Four (4) years of case management experience preferred or equivalent experience
Prior quality assurance and/or training a plus
Current RN licensure

Nice To Haves

Bachelor of Science degree or Bachelor of Science in Nursing preferred
CCM preferred
Four year degree from an accredited college or university preferred
Certified Trainer and/or Quality Assurance distinction preferred
Four (4) years of case management experience preferred or equivalent experience
Prior quality assurance and/or training a plus

Responsibilities

Develop, implement, and provide ongoing quality assurance calibration of processes as well as a case management mentoring, both managed and delivered at the operational level
Educate and equip operations with performance measurement and reporting tools that can be used to objectively measure and grow operations
Provide national account and regulatory quality oversight
As applicable, provide oversight and management of URAC compliance and renewals
Work with executive, general and case management department management to ensure the case management department successfully implemented and is adhering to CorVel standards (including quality assurance, reporting, and management processes)
Work closely with new hires to ensure consistent and full integration/training of all case management managers to CorVel standards as well as training for system usage pertaining to case management and reporting
Identify developmental needs and participate in training of case management leadership, including the training/re-training of all offices on standards and procedures, and usages of the CorVel case management and reporting system
Develop, run and interpret management reports to ensure the case management operations are utilizing the tools available to manage compliance of services delivery within company standards
Facilitate peer-to-peer quality reviews to ensure delivery of quality case management
Review results and outcomes with general management and case management leadership and develop action plans where warranted
Make recommendations in collaboration with field operations to ensure actions toward improvement are identified
Develop and oversee case management manager mentor program to facilitate the onboarding of new supervision and management to equip field with the tools for compliance and consistency of CorVel standards and procedures
Implementation, oversight and communication of regulatory requirements within case management services to include, state, federal and URAC
Identify trends and recommend action plans to management for continuous process improvement
Ability to travel up to fifty percent of the time
Additional duties as assigned