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Clinical Quality Specialist RN

US Tech Solutions, Inc Watertown, MA Full-Time
$106,260.00 (Careerbuilder est.) What is the Careerbuilder Estimated Salary? Only about 20% of the jobs in our search results contain salary information. When a job posting doesn’t include a salary, we estimate it by looking at similar jobs in the same industry in that location. It is not necessarily endorsed by the employer and actual compensation may vary based on your experience.
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US Tech Solutions is seeking a Clinical Quality Specialist RNfor 03-04 Months Contract with a client in Watertown, MA

Description:                                                  

  • Review initial research on clinical grievances. 
  • Ensure each assigned clinical grievance is categorized per department standard.
  • Correspond with the member as required (closure letters and telephone contact as appropriate).
  • Correspond with the provider as required (written inquiry, closure letters and telephone contact) as defined by department standards.
  • Complete data entry and documentation requirements in multiple information systems including but not limited to MedHOK.
  • Interact with staff at various levels within THP departments in facilitation, identification and resolution of the member’s grievance.
  • Independently assign grievance ratings per department policy.
  • Ensure each assigned QI Occurrence is categorized per department standard.
  • Complete data entry and documentation requirements in multiple information systems including but not limited to MedHOK.
  • Independently assign grievance ratings per department policy.
  • Conducts the review of QI events, including determination of follow up actions, rating the case, and ensuring activities needed to close each case.
  • Collaborates with medical director/clinical reviewer as needed for case review and follow-up.
  • Coordinates communication efforts (i.e., letter writing, phone calls) as indicated to pursue quality of care reviews/issues.

Education:

  • BA/BS degree preferred; Registered Nurse with current unrestricted Massachusetts license required.

Experience:

  • Minimum of five years of clinical nursing experience required.
  • Experience in managed care systems and operations, is highly desirable.
  • Experience in Health Care Quality is highly desirable.

Skills:

  • Critical and Analytic thinking – must understand cause and effect, internal and external impact of business changes and THP information systems.
  • Coaching and Mentoring - primarily of reports.
  • Regard for confidential data and adherence to corporate compliance policy.
  • Proficiency with or ability to learn technology for initiating and participating in web/system-based communications: webinar, instant messaging, thin client, soft phone or others.
  • Proficiency with or ability to learn technology-based programs such as Microsoft Word and Excel; other programs that support the department function.


About US Tech Solutions:  


Your talent, our opportunities - This is the premise behind US Tech Solutions.

You have the skill we have the opportunity. As a team, we work passionately for you to get the right career opportunity across industry verticals and functions. For past sixteen years, leading Global

Companies and Fortune 500 come to us to get the right talent. Whether you want to work as full-time, contractor or part-time, technical or non-technical our talent consultants will connect with the right career opportunity globally.

Connect with our talent team today.

USTECH was founded in 2000 by Manoj Agarwal. Today, we are a global firm offering talent solutions to 150 customers including 20% of Fortune 500 across Financial Services, Healthcare, Life Sciences, Aerospace, Energy, Retail, Telecom, Technology, Manufacturing, and Engineering. We are headquartered in New Jersey with 40 global locations across the USA, Canada, Europe, and India. Deloitte has recognized USTECH as one of the fastest growing private businesses for the past five consecutive years and INC 500 for the past three. We have also been rated “The Top Business in the US" by Diversity Business since 2011. To learn more about how US Tech Solutions visit our website: www.ustechsolutions.com.

“US Tech is an Equal Opportunity Employer" and “US Citizens & all other parties authorized to work in the US are encouraged to apply."

URL blocked - click to apply: Interested candidates are requested to send their resume to URL blocked - click to applySayan at URL blocked - click to apply


US Tech Solutions is seeking a Clinical Quality Specialist RNfor 03-04 Months Contract with a client in Watertown, MA

Description:                                                  

  • Review initial research on clinical grievances. 
  • Ensure each assigned clinical grievance is categorized per department standard.
  • Correspond with the member as required (closure letters and telephone contact as appropriate).
  • Correspond with the provider as required (written inquiry, closure letters and telephone contact) as defined by department standards.
  • Complete data entry and documentation requirements in multiple information systems including but not limited to MedHOK.
  • Interact with staff at various levels within THP departments in facilitation, identification and resolution of the member’s grievance.
  • Independently assign grievance ratings per department policy.
  • Ensure each assigned QI Occurrence is categorized per department standard.
  • Complete data entry and documentation requirements in multiple information systems including but not limited to MedHOK.
  • Independently assign grievance ratings per department policy.
  • Conducts the review of QI events, including determination of follow up actions, rating the case, and ensuring activities needed to close each case.
  • Collaborates with medical director/clinical reviewer as needed for case review and follow-up.
  • Coordinates communication efforts (i.e., letter writing, phone calls) as indicated to pursue quality of care reviews/issues.

Education:

  • BA/BS degree preferred; Registered Nurse with current unrestricted Massachusetts license required.

Experience:

  • Minimum of five years of clinical nursing experience required.
  • Experience in managed care systems and operations, is highly desirable.
  • Experience in Health Care Quality is highly desirable.

Skills:

  • Critical and Analytic thinking – must understand cause and effect, internal and external impact of business changes and THP information systems.
  • Coaching and Mentoring - primarily of reports.
  • Regard for confidential data and adherence to corporate compliance policy.
  • Proficiency with or ability to learn technology for initiating and participating in web/system-based communications: webinar, instant messaging, thin client, soft phone or others.
  • Proficiency with or ability to learn technology-based programs such as Microsoft Word and Excel; other programs that support the department function.


About US Tech Solutions:  


Your talent, our opportunities - This is the premise behind US Tech Solutions.

You have the skill we have the opportunity. As a team, we work passionately for you to get the right career opportunity across industry verticals and functions. For past sixteen years, leading Global

Companies and Fortune 500 come to us to get the right talent. Whether you want to work as full-time, contractor or part-time, technical or non-technical our talent consultants will connect with the right career opportunity globally.

Connect with our talent team today.

USTECH was founded in 2000 by Manoj Agarwal. Today, we are a global firm offering talent solutions to 150 customers including 20% of Fortune 500 across Financial Services, Healthcare, Life Sciences, Aerospace, Energy, Retail, Telecom, Technology, Manufacturing, and Engineering. We are headquartered in New Jersey with 40 global locations across the USA, Canada, Europe, and India. Deloitte has recognized USTECH as one of the fastest growing private businesses for the past five consecutive years and INC 500 for the past three. We have also been rated “The Top Business in the US" by Diversity Business since 2011. To learn more about how US Tech Solutions visit our website: www.ustechsolutions.com.

“US Tech is an Equal Opportunity Employer" and “US Citizens & all other parties authorized to work in the US are encouraged to apply."

URL blocked - click to apply: Interested candidates are requested to send their resume to URL blocked - click to applySayan at URL blocked - click to apply


Recommended skills

Communication
Research
Documentation
Operations
Coaching And Mentoring
Mentorship

Location

CareerBuilder Estimated Salary What is the Careerbuilder Estimated Salary? Only about 20% of the jobs in our search results contain salary information. When a job posting doesn’t include a salary, we estimate it by looking at similar jobs in the same industry in that location. It is not necessarily endorsed by the employer and actual compensation may vary based on your experience.

x

What is the Careerbuilder Estimated Salary?

Only about 20% of the jobs in our search results contain salary information. When a job posting doesn’t include a salary, we estimate it by looking at similar jobs in the same industry in that location. It is not necessarily endorsed by the employer and actual compensation may vary based on your experience.
This estimation is based on Job title, Industry, Location and Skills
$106,260
Avg. Yearly Salary
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