Top 7 Quality assurance nurse Jobs in Rancho Cucamonga, Ca

Provider Quality Review Nurse, RN
Inland Empire Health Plan —Rancho Cucamonga, CA
- $91,249.60 - $120,910.40 a year
- Full-time
- Hybrid work
- Nursing
- RN License
- Word processing
- Disability insurance
- Health insurance
RN - Quality Assurance/Utilization Review - Business Development - Full Time 8hr Covina, California
Emanate Health —Covina, CA
- $52.03 - $80.64 an hour
- 8 hour shift
- RN License
- Customer service
- Computer literacy
- Health insurance
- Dental insurance
LVN - Quality Assurance/Utilization Review - Business Development - Full Time 8hr
Emanate Health —Covina, CA
- $31.03 - $46.54 an hour
- 8 hour shift
- LVN
- Customer service
- Computer literacy
Quick Apply
6d
LVN - Quality Assurance/Utilization Review - Business Development - Full Time 8hr Covina, California
Emanate Health —Covina, CA
- $31.03 - $46.54 an hour
- 8 hour shift
- LVN
- Customer service
- Computer literacy
RN - Quality Assurance/Utilization Review - Business Development - Full Time 8hr
Emanate Health —Covina, CA
- $52.03 - $80.64 an hour
- 8 hour shift
- RN License
- Customer service
- Computer literacy
Quick Apply
6d
LVN or RN Quality Improvement (QI) in office
BLEHEALTH, LLC —Pomona, CA
- Full-time
- Spanish
- Nursing
- LVN
Quick Apply
Regional QA Consultant - Skilled Nursing
Renew Health Consulting Services —Monrovia, CA
- $160,000 - $200,000 a year
- Full-time
- Skilled nursing facility
- RN License
- 5 years
- Health insurance
- Dental insurance
Quick Apply

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Provider Quality Review Nurse, RN

Inland Empire Health Plan -
Rancho Cucamonga, CA

Apply Now

Job Details

Full-time
$91,249.60 - $120,910.40 a year

Benefits

457(b)
Disability insurance
Health insurance
On-site gym
Dental insurance
Flexible spending account
Vision insurance
Opportunities for advancement
Life insurance

Qualifications

RN License
Driver's License

Full Job Description

Overview:

This is a short-term assignment.

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

At Inland Empire Health Plan (IEHP), we believe the highest quality of care should be delivered to all in the Inland Empire. We are thinking beyond the way Quality is viewed today – we believe it should be holistic and transformative. IEHP’s provider incentive programs serve an important role in achieving IEHP’s quality goals.

Reporting to the Manager of Provider Quality Oversight, the Provider Quality Review Nurse, RN is responsible for:

Receive and research all PQI and QR cases as assigned, provide a summary and recommendations to the Medical Director of case assignments
Effectuate all action items as determined by the Medical Director to resolution of case assignments
Reviewing escalated issues
Discussing and reviewing cases with Medical Directors referred to the Quality Management (QM) department
Investigation of cases includes, but not limited to, the documentation of case summaries, follow up actions, outreach efforts, and communications in the QM database

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Additional Benefits:

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

Competitive salary.
Hybrid schedule.
CalPERS retirement.
State of the art fitness center on-site.
Medical Insurance with Dental and Vision.
Life, short-term, and long-term disability options
Career advancement opportunities and professional development.
Wellness programs that promote a healthy work-life balance.
Flexible Spending Account – Health Care/Childcare
CalPERS retirement
457(b) option with a contribution match
Paid life insurance for employees
Pet care insurance

Key Responsibilities:

Investigate and complete case summaries and make recommendations for any Potential Quality of Care Incidents (PQI) referred to the QM department.
Maintain direct communication with IEHP departments, external facilities including hospitals, Skilled Nursing Facilities, and/or Providers to ensure all PQI issues are thoroughly investigated, and care is coordinated in a timely manner, as needed.
Review requested medical records to ensure complete case documentation is received from all practitioners, providers, and entities/agencies to ensure thorough investigation of the issue.
Review case findings and recommendations with Medical Director. Issue Corrective Action Plans (CAP), review CAP responses, draft Opportunity for Improvement letters, and coordinate other interventions as needed to ensure all issues were addressed and future occurrences of the same issue are mitigated.
Complete data entry into database systems, maintain updated documentation and other tracking mechanisms for all cases.
Review and execute ad hoc requests, quality reviews, and/or focused audits, as needed.
Escalate issues of non-compliance to the Quality Systems Management team.
Maintain working knowledge of regulatory requirements as they relate to QM operations and protocols.
Complete other tasks and assignments based on department and business needs.
Demonstrate a commitment to incorporate LEAN principles into daily work.

Qualifications:

Education & Requirements

Three (3) or more years of any individual or combined healthcare experience in quality assurance, quality management, quality improvement, utilization management, discharge planning, and/or case management
Three (3) or more years of work experience in a managed care, hospital, provider practice, or other comparable healthcare experience
Experience preferably in a quality/performance improvement setting
Bachelor's degree in Nursing from an accredited institution required
- In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position
- This experience is in addition to the minimum years listed in the Experience Requirements above
Certified Professional in Healthcare Quality (CPHQ), Certified Professional in Healthcare Risk Management (CPHRM), or Clinical certification in area specialty) preferred
Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required

Key Qualifications

Must have a valid California Driver's License
Excellent understanding of performance improvement, quality assurance, and utilization management
Knowledgeable in clinical analysis of health records, assessing or evaluating quality, and identifying problems or issues with care delivery
Microcomputer applications: spreadsheet, database, and word processing
Excellent written and verbal communication skills
Excellent coordination skills
Ability to communicate findings and form recommendations based on clinical case reviews
Ability to demonstrate critical thinking, strong problem-solving capability. Strong attention to detail
Ability to prioritize work to ensure adherence to project deadlines. Ability to effectively escalate issues as identified, following established protocols
Positive attitude and ability to work in a team setting
Self-direction and ability to work with minimal supervision
Word processing and data entry involving computer keyboard and screens, automobile travel within the Inland Empire
Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval

Start your journey towards a thriving future with IEHP and apply TODAY!

Work Model Location:

Telecommute (All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership)

Pay Range: USD $91,249.60 - USD $120,910.40 /Yr.

Apply Now

Refine Your Search

quality assurance nurse jobs in rancho cucamonga, ca

Provider Quality Review Nurse, RN

RN - Quality Assurance/Utilization Review - Business Development - Full Time 8hr Covina, California

LVN - Quality Assurance/Utilization Review - Business Development - Full Time 8hr

LVN - Quality Assurance/Utilization Review - Business Development - Full Time 8hr Covina, California

RN - Quality Assurance/Utilization Review - Business Development - Full Time 8hr

LVN or RN Quality Improvement (QI) in office

Regional QA Consultant - Skilled Nursing

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