Nurse Jobs

About The Position

Requirements

• Possession of a valid State of Florida Registered Nurse license
• Five years of general medical or surgical nursing experience to include two years performing Quality Assurance, Utilization Review or Case Management duties
• Possession of a valid Florida Driver’s License
• Ability to collect, organize and evaluate data and to develop logical conclusions.
• Ability to follow oral and written instruction and ability to use a computer and related software.
• Ability to prioritize work and work effectively with others.
• Ability to communicate effectively both orally and in writing.
• Maintain the ability to pass the background checks required for the position. These background checks may include but are not limited to: Criminal History Background Check using Florida Department of Law Enforcement (FDLE) Criminal Justice Information Services (CJIS) Level 1 and Level 2 Background screening (Ch. 435 Florida Statutes) Child Abuse, Abandonment and Neglect Record Check using the State Automated Child Welfare Information System (SACWIS) Sex Offender and Sexual Predator record check using the list maintained by the Florida Department of Law Enforcement (FDLE)

Nice To Haves

• Knowledge of Federal, State and community resources within Hillsborough County is preferred.
• Bilingual in English and Spanish
• At least three years experience working with Excel and Word.
• Experience working for a payor/insurance provider is desired.

Responsibilities

• Monitor procedural compliance of network providers.
• Pursue quality of care inquiries.
• Review medical records to determine accepted standards of care have been rendered and appropriately performed.
• Plan agenda and prepare materials for HCAB Medical Subcommittee and Drug Review Committee meetings and promote attendance.
• Attend Committee meetings and provide input and direction as applicable.
• Function as a quality assurance liaison between the networks, providers and hospitals on client issues.
• Participate and assist with the performance improvement programs of networks, providers and hospitals.
• Provide patient outcome feedback as requested.
• Identify training issues, prepares reports and related documentation.
• Execute special projects involving the care of HCHCP clients.
• Perform other special assignments, research and prepare reports, develop and implement programs.
• Performs other related duties as required.