Quality Assurance Nurse

🔥 8 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $61.1k - $98.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔧 QA Engineer (Quality Assurance)

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CorVel Corporation

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1987

🤝 B2B

⚕️ Healthcare Insurance

☁️ SaaS

B2B • Healthcare Insurance • SaaS

CorVel Corporation is a risk management and healthcare services company that provides integrated claims and care solutions for payors and employers. It specializes in workers' compensation, liability and disability management, provider and pharmacy networks, and alternative risk solutions, and it offers technology platforms that use AI and data analytics to streamline claims administration, improve outcomes, and reduce costs.

📋 Description

• Develop, implement, and provide ongoing quality assurance calibration of processes as well as a case management mentoring, both managed and delivered at the operational level • Educate and equip operations with performance measurement and reporting tools that can be used to objectively measure and grow operations • Provide national account and regulatory quality oversight • As applicable, provide oversight and management of URAC compliance and renewals • Work with executive, general and case management department management to ensure the case management department successfully implemented and is adhering to CorVel standards (including quality assurance, reporting, and management processes) • Work closely with new hires to ensure consistent and full integration/training of all case management managers to CorVel standards as well as training for system usage pertaining to case management and reporting • Identify developmental needs and and participate in training of case management leadership, including the training/re-training of all offices on standards and procedures, and usages of the CorVel case management and reporting system • Develop, run and interpret management reports to ensure the case management operations are utilizing the tools available to manage compliance of services delivery within company standards • Facilitate peer-to-peer quality reviews to ensure delivery of quality case management • Review results and outcomes with general management and case management leadership and develop action plans where warranted • Make recommendations in collaboration with field operations to ensure actions toward improvement are identified • Develop and oversee case management manager mentor program to facilitate the onboarding of new supervision and management to equip field with the tools for compliance and consistency of CorVel standards and procedures • Implementation, oversight and communication of regulatory requirements within case management services to include, state, federal and URAC • Identify trends and recommend action plans to management for continuous process improvement • Ability to travel up to fifty percent of the time

🎯 Requirements

• Graduate of accredited school of nursing with a diploma/Associates degree (Bachelor of Science degree or Bachelor of Science in Nursing preferred) • 3 or more years of recent clinical experience, preferably in rehabilitation • National certification (CRC, CIRS, CCRN, CVE, CCM, etc.), CCM preferred • Four year degree from an accredited college or university preferred • Certified Trainer and/or Quality Assurance distinction preferred • Four (4) years of case management experience preferred or equivalent experience • Prior quality assurance and/or training a plus • Current RN licensure

🏖️ Benefits

• Medical (HDHP) w/Pharmacy • Dental • Vision • Long Term Disability • Health Savings Account • Flexible Spending Account Options • Life Insurance • Accident Insurance • Critical Illness Insurance • Pre-paid Legal Insurance • Parking and Transit FSA accounts • 401K • ROTH 401K • paid time off