RN - Quality of care Investigative Nurse

Schedule

The first day requires in-person attendance for equipment collection and completion of necessary security training to access systems. Subsequent onboarding and training will be conducted remotely. The work schedule is 8am-5pm, Monday through Friday, totaling 40 hours per week.

This position is part of the Quality Management Unit and involves conducting quality-of-care investigations in accordance with relevant contracts and regulations. The role focuses on both member-centric and systemic quality concerns to ensure the health and well-being of members.

Responsibilities include conducting timely and thorough investigations of all quality-of-care issues and implementing vendor-specific corrective action plans using a standardized process. The role involves making appropriate referrals to oversight and regulatory agencies, participating in various member-related concerns and issues, and maintaining comprehensive documentation for case work.

The position requires requesting and maintaining necessary documentation for investigations and ensuring all relevant information is uploaded to the appropriate portal. The role also involves elevating cases and trend concerns to supervisors as needed.

Skills

• Critical thinking
• Technological proficiency, including databases, Microsoft Office, email, and electronic resources
• Ability to produce professional technical reports and letters
• Research and analysis skills
• Strong oral and written communication skills
• Personal planning, organization, and time management
• Medical chart review
• Proficiency in the nursing process, including assessment, monitoring, and evaluation
• Decision-making skills
• Ability to critically analyze problems and develop effective corrective action plans

Required Education

Registered Nurse (RN) license in the appropriate jurisdiction.