Top 7 Quality assurance nurse Jobs in Newark Nj

Clinical Quality Reviewer
US Family Health Plan @ SVCMC, Inc. —New York, NY
- $80,000 - $115,000 a year
- Full-time
- Nursing
- Anatomy knowledge
- Microsoft Outlook
Quick Apply
9d
Wellness Quality Assurance, Nurse Manager
1199SEIU Family of Funds —New York, NY
- $111,000 - $164,000 a year
- Weekends as needed
- Microsoft Word
- Spanish
- Nursing
Nursing Coordinator for Quality and Performance Improvement
Montefiore Mount Vernon —Mount Vernon, NY
- $108,000 - $135,000 a year
- Full-time
- Nursing
- RN License
- Mid-level
Clinical Quality Improvement Nurse Educator
Community Healthcare Network Inc —New York, NY
- $108,000 - $115,000 a year
- Full-time
- CPR Certification
- Nursing
- BLS Certification
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Hospice Quality RN
Calvary Hospital —Bronx, NY
- $112,484 - $138,984 a year
- Full-time
- Nursing
- RN License
- Analysis skills
- Health savings account
- Health insurance
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Utilization Review Nurse
HAMASPIK CHOICE INC —Spring Valley, NY
Valid New York State, unrestricted, RN license. The UM Nurse manages providers, members, or care manager generated requests for medical services and renders…
$45 - $47 an hour
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Utilization Review Nurse (Medicare)
HAMASPIK CHOICE INC —Spring Valley, NY
Valid New York State, unrestricted, RN license. The UM Nurse manages providers, members, or care manager generated requests for medical services and renders…
$41 - $47 an hour
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Clinical Quality Assurance Specialist, RN
Wider Circle —Columbus, OH
An active, unrestricted RN, NP, LPN, or LCSW license (a multi-state or compact license is preferred). You can pull, sort, and understand QA data on your own.
$80,000 - $95,000 a year
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Clinical Reviewer - Medical Coder & QA
Ohio Living —Westerville, OH
Current unencumbered license for the state of Ohio to practice as a Licenses Practical Nurse (LPN) preferred Certificate for OASIS Specialist-Clinical…
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Clinical Quality Reviewer

US Family Health Plan @ SVCMC, Inc. -
New York, NY

Quick Apply

Job Details

Full-time
$80,000 - $115,000 a year
9 days ago

Qualifications

Nursing
Quality control experience within healthcare industry
Quality of care (regulatory compliance area)
Data-driven problem-solving
Nursing
Quality assurance experience within healthcare

Full Job Description

JOB SUMMARY

Reports to Team Lead, Clinical Quality and Record Review. Works independently and with other departments and/or vendors to ensure clinical potential quality issues are tracked, investigated and resolved in accordance with TRICARE and Plan requirements. Primarily responsible for conducting post-service in-depth clinical reviews (all care settings) in accordance with accepted standards of care. The overall goal is to improve clinical service delivery.

RESPONSIBILITIES

Clinical Review

Utilizes clinical expertise to conduct clinical case retrospective reviews to determine deviation from standard of care or gaps in care and presence of mandatory data elements. Document progress of investigation and findings in internal databases and/or Excel spreadsheets.
Conduct clinical literature reviews and summarize findings.
Contact providers/facilities, as applicable, to obtain information and/or medical records needed to conduct a comprehensive clinical review of cases and final determinations.
Conduct chart reviews and audits both electronic and at medical facilities and providers’ offices. Abstract data relevant to review target.
Write succinct and targeted investigative summaries. Write quality review determination letters.
Develop and manage collaborative relationships with internal/external stakeholders and vendor staff.
Maintain confidentiality of all medical records, correspondence and related documents.
Effectively meets strict deadlines.
Aware of the potential for fraud and waste and how to report suspected fraudulent activity.

Data Analysis and Reporting

Participate in collection and analysis of data for clinical CDRLs reports (i.e., monthly quality issue report, AHRQ PSI report, annual clinical quality management program report).
Participate in collection, analysis and presentation of data for Peer Review, Credentials Review and Quality Committees.
Evaluate data for trends.

Continuous Quality Improvement

Participate in continuous quality improvement activities/root cause analysis to resolve identified quality issues and ensure forward movement in beneficiary service delivery.
Cross-train and perform other duties as assigned or required within the Quality Department. Attends meetings to achieve departmental/organizational goals and objectives.

Experience

Five years of healthcare quality management experience.
Five years clinical nursing experience.
Quality assurance/improvement experience in a managed health plan, integrated health care system, or health care accreditation or regulatory agency.

Skills/Competencies

Ability to read, abstract and analyze medical records as well as other clinical data.
Analytical mindset with excellent organizational and problem-solving skills.
Ability to work both independently and as a team member.
Strong project management skills.
Intermediate statistical analysis expertise including interpretation of data.
Communications: Effective verbal and written communication skills. Able to work collaboratively with different teams and different team members. Ability to work both independently and as a team member.
Manages assigned caseload in accordance with established performance metrics.
Excellent customer service skills.
Understanding of medical terminology, anatomy, physiology and concepts of disease and health. Fundamental knowledge of ICD-10, CPT and HCPCS coding.
Understanding of Medicare, Medicaid and/or TRICARE.
Proficient in Microsoft Office, including but not limited to Excel, Outlook, PowerPoint and Word. Experience in Access and Visio a plus. Ability and inclination to adopt technology to maximize efficiency.
Decision making: Identification of clinical quality issues as evidenced by deviation from accepted standard of practice or gap in care. Ability to recommend corrective actions and/or sanctions.

Education/Certifications/License

Current and unrestricted state RN or LPN/LVN license required (CT, NJ, NY, PA)
BA, BS, or BSN preferred

SALARY RANGE: LPN/LVN $80,000 – $85,000.00 RN $107,000.00 - $115,000.00

SVCMC IS AN EQUAL OPPORTUNITY EMPLOYER - ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT

WITHOUT REGARD TO VETERAN STATUS, DISABILITY, OR OTHER CHARACTERISTICS PROTECTED BY LAW.

Mondays & Fridays Remote
Tuesday through Thursday In Office

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Refine Your Search

quality assurance nurse jobs in newark nj

Clinical Quality Reviewer

Wellness Quality Assurance, Nurse Manager

Nursing Coordinator for Quality and Performance Improvement

Clinical Quality Improvement Nurse Educator

Hospice Quality RN

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