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Quality Nurse Specialist - Fully Remote

Company: Kepro
Location: Harrisburg
Posted on: January 16, 2022

Job Description:


Quality Nurse Specialist
Are you an experienced Quality Nurse Specialist looking for a new challenge?
Do you value care management and quality improvement?
Are you motivated, energetic, and excited to become part of the Kepro team?

If so, you might be our next new team member!

This is a fully remote position.

Who We Need

Works in conjunction with the Operations Manager of the Tricare Contract to oversee the day to day activities of the nurse reviewers and abstractors in assigned areas to successfully meet contract deliverables. Assists in meeting deliverables related to the Review Department within budgetary parameters. Supports the operations manager with implementation and coordination of testing and quality assurance to support the program or contract. Identifies/plans/Coordinates/implements quality improvement projects using knowledge of performance improvement strategies, principles, methodology, techniques and data analysis. Uses measurable indicators and outcome measurements to determine whether the desired organizational results are achieved.

Why us?

Kepro is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting.

People Focused. Mission Driven.

Shape the future of healthcare with us. We are mission driven to improve lives through healthcare quality and clinical expertise.

We do this through our people.

At Kepro, you can do meaningful work that makes a real difference for the lives of individuals across the country. We are an organization that cares deeply about our employees and we provide the training and support to do the best work of your career.

Benefits are a key component of your rewards package at Kepro. These benefits are designed to provide you and your family additional protection, security, and support for both your career and your life away from work. They are comprehensive and fit a variety of needs and situations. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts and more.

What You'll Do
Maintains current information on clinical practice guidelines, health tech assessments, research studies, policies and recommendations for expert medical testimony.
Maintains a policy library.
Assists client/customer with issues relating to policy implementation, processes and appeals and appeals decisions.
Ongoing planning, development, and maintenance of internal monitoring program for review activities performed by clinical review team.
Develops, coordinates and implements testing and quality assurance measures and activities.
Assesses potential problems and recommends corrective actions to resolve or mitigate associated risks.
Monitors the implementation of testing and quality assurance policies, processes and procedures to ensure uniform application across the board.
Prepares and submits reports and/or deliverables timely as required
Knowledge of Interqual Criteria strongly preferred.
Knowledge of current NCQA/URAC standards strongly preferred.
Must be proficient in Microsoft Office and internet/web navigation.
Medical record abstracting skills required.
Knowledge of the organization of medical records, medical terminology, and disease process required.
Strong clinical assessment and critical thinking skills required.
Excellent verbal and written communication skills required.
Ability to work in a team environment.
Flexibility and strong organizational skills needed.
Assures accuracy and timeliness of all applicable review type cases within contract requirements.
Analyzes productivity of nurse reviewers and abstractors
Performs all applicable review types as workload indicates.
Functions as providers' liaison and contact/resource person for provider customer service issues and problem resolution.
Maintains current knowledge base related to review processes and clinical practices related to the review processes; functions as the initial resource to nurse reviewers/abstractors regarding all review process questions and/or concerns.
Responsible for the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas.
Identify Clinical Reviewers' orientation and continuous learning needs and in collaboration with the Manager, Operations, develops and implements plans to address those identified learning needs.
Assesses, evaluates and addresses daily work load and queues; adjusts work schedules daily to meet the workload demands of the department.
For Remote work will require access to phone, internet and secure workspace for the working environment

What You'll Need
Unrestricted RN, LPN License with Minimum two years of clinical experience in an acute or med-surgical environment required.
Minimum of one year UR and/or Prior Authorization or related experience

Thank You!

We know your time is valuable and we thank you in advance for applying for this position. Due to the high volume of applicants we receive, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Kepro and invite you to apply to future openings that may be of interest. Best of luck in your search!

- The Kepro Talent Acquisition Team

Mental And Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.

EOE AA M/F/Vet/Disability

Kepro is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Keywords: Kepro, Harrisburg , Quality Nurse Specialist - Fully Remote, Healthcare , Harrisburg, Pennsylvania

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