Quality Assurance Nurse

CorVel Corporation•Waukesha, WI

5d•$61,053 - $98,334•Remote

About The Position

The Quality Assurance Nurse is responsible for quality assurance and mentorship for case management operations staff, providing tools and calibrating processes to ensure consistent delivery of CorVel’s case management services. The role develops and implements quality assurance processes, supports staff training and onboarding, and provides national account and regulatory oversight, including URAC compliance and renewals as applicable. Working with executive, general, and case management leadership, the Quality Assurance Nurse ensures that the case management department implements and adheres to CorVel standards for quality assurance, reporting, and management. The position develops and interprets management reports, facilitates peer-to-peer reviews, evaluates outcomes, and collaborates with field operations on action plans and continuous improvement. Travel may be required up to 50% of the time.

Requirements

Graduate of an accredited school of nursing with a diploma or associate degree.
Three or more years of recent clinical experience; rehabilitation experience preferred.
Current RN licensure.
Strong knowledge of clinical and case management processes.
Strong knowledge and experience in quality assurance and training programs.
Excellent oral and written communication skills.
PC literacy, including Microsoft Word and Excel.
Ability to identify case management office improvement opportunities and communicate and implement solutions.
Ability to remain poised in stressful situations and communicate diplomatically.
Ability to manage multiple complex projects and competing priorities under pressure, meet deadlines, and maintain a strong customer service orientation.
Effective quantitative and analytical skills.
Strong organizational skills.
Ability to work independently or in a team environment, functioning as an educator rather than an auditor.
Knowledge of claims administration, case management, and cost containment solutions as applicable to third-party administrator operations.

Nice To Haves

Bachelor of Science degree or Bachelor of Science in Nursing.
National certification such as CRC, CIRS, CCRN, CVE, or CCM; CCM preferred.
Four-year degree from an accredited college or university.
Certified Trainer and/or Quality Assurance distinction.
Four years of case management experience or equivalent experience.
Prior quality assurance and/or training experience.

Responsibilities

Develop, implement, and provide ongoing quality assurance calibration of operational processes and case management mentoring.
Educate and equip operations staff with performance measurement and reporting tools to objectively measure and improve operations.
Provide national account and regulatory quality oversight.
Oversee and manage URAC compliance and renewals as applicable.
Work with executive, general, and case management leadership to ensure implementation and adherence to CorVel standards, including quality assurance, reporting, and management processes.
Support new hires with integration and training for case management managers, CorVel standards, and case management and reporting system usage.
Identify developmental needs and participate in training case management leadership, including training or retraining offices on standards, procedures, and system usage.
Develop, run, and interpret management reports to assess use of available tools and compliance with company service-delivery standards.
Facilitate peer-to-peer quality reviews of case management services.
Review results and outcomes with general management and case management leadership and develop action plans when warranted.
Collaborate with field operations to recommend actions for improvement.
Develop and oversee a case management manager mentor program for onboarding new supervisors and managers and supporting compliance and consistency.
Implement, oversee, and communicate state, federal, and URAC regulatory requirements for case management services.
Identify trends and recommend action plans to management for continuous process improvement.
Travel up to 50% of the time.
Perform additional duties as assigned.