We are seeking a QI Nurse Specialist (RN) (PQI) to join our quality improvement team in a full telework capacity within California.
Key Responsibilities:
- Conduct clinical assessments of member complaints and urgent issues, supporting high-quality, member-centered care.
- Participate in handling quality of care grievances and investigations for potential quality issues, ensuring compliance with regulations and policies.
- Develop thorough clinical review reports, collect appropriate data, and facilitate case closure with medical and organizational leadership.
- Maintain departmental database integrity through accurate case documentation and participate in meetings, training, and audits.
- Foster a culture of compliance, ethics, and continuous improvement.
Qualifications & Skills:
- California RN license with a bachelor’s degree in nursing and at least 5 years of patient care experience, including 2 in acute care.
- Preferred certifications: CCM or CPHQ; experience in managed care and project management are advantageous.
- Strong communication, analytical, problem-solving, and relationship-building skills, with the ability to work independently in a fast-paced environment.
- Proficiency in computer software such as Microsoft Office and relevant systems.
Additional Requirements:
- Ability to read and communicate clearly, lift objects up to 25 pounds, and adapt to a flexible schedule.
- Access to transportation for occasional work outside primary location.
Benefits include competitive salary, full telework eligibility, comprehensive benefits, retirement plans, PTO, wellness programs, tuition reimbursement, and professional growth opportunities.