Top 13 Rn hoag Jobs | SimplyHired

Quality Review RN : Hospice
Hoag Health System —Newport Beach, CA
- Full-time
- RN License
- Mid-level
- Bachelor's degree
Clinical Nurse I: Irvine Cancer Outpatient Treatment Center
Hoag Health System —Irvine, CA
- Full-time
- Nursing
- RN License
- BLS Certification
12d
Program Manager Nursing Education and Magnet Coordinator (RN): Nursing Education
Hoag Health System —Newport Beach, CA
- Full-time
- Nursing
- RN License
- Mid-level
5d
Clinical Nurse II: CCU
Hoag Health System —Newport Beach, CA
- Nursing
- RN License
- BLS Certification
5d
Clinical Nurse II: Chemical Dependency
Hoag Health System —Newport Beach, CA
- Nursing
- RN License
- BLS Certification
Director Patient Care Services : Hoag at Home Administration
Hoag Health System —Newport Beach, CA
- Nursing
- Medicine
- RN License
Clinical Nurse II: Irvine Dermatology Oncology
Hoag Health System —Irvine, CA
- Nursing
- RN License
- Hospital
Clinical Nurse III : Heart Catherization Lab
Hoag Health System —Newport Beach, CA
- Nursing
- RN License
- Hospital
Clinical Nurse Navigator I (RN) : Pain Management
Hoag Health System —Newport Beach, CA
- Full-time
- Spanish
- Nursing
- Surgery
13d
Patient Care Assistant/Certified Nurse Assistant (CNA) - Medical/Surgical & Telemetry
Hoag Health System —Newport Beach, CA
- 12 hour shift
- Nursing
- LVN
- Patient monitoring
Clinical Nurse II: Medical Oncology Specialty Clinic
Hoag Health System —Newport Beach, CA
- Nursing
- Surgery
- RN License
13d
Director Clinical Transplant Services : Abdominal Transplant Administration
Hoag Health System —Newport Beach, CA
- Weekends as needed
- Nursing
- 5 years
- Bachelor's degree
Clinical Nurse II: Medsurg - 3 East-Brain & Spine Unit
Hoag Health System —Newport Beach, CA
- Nursing
- Surgery
- RN License
7h

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Quality Review RN : Hospice

Hoag Health System -
Newport Beach, CA

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Job Details

Full-time

Qualifications

RN License
Health insurance knowledge
Nursing

Full Job Description

Primary Duties and Responsibilities

The Quality Management (QM) Nurse is responsible for preparing, reviewing, and presenting findings on all potential quality management events reported to the department and all grievances submitted to the Medical Director, Health Plan (HP) and/or Quality Management Committee (QMC) based upon department policies and procedures.
Depending on each Health Plan’s reporting requirements, the QM Nurse reviews all submitted grievances, supporting documentation and prepares a response to the Health Plan partners for their review and determination.
The QM Nurse tracks the activities related to the grievance until the Health Plan releases a final determination.
The QM Nurse documents all activities in the Quality Management System for monitoring and Committee reporting.
The QM Nurse participates in any quality management projects as assigned.
The QM Nurse assists in the coordination and collection of HEDIS medical records, identifies potential gaps in care/quality of care, provides recommendations to the committee on resolving gaps identified and conducts assigned department audits as appropriate.
The role involves a high level of data collection, intensive patient care review, and implementing process improvement activities.
This position participates in the QMC by providing the QM activity reports to the committee.
Other duties as assigned.

Education and Experience

At least 3 to 5 years of Nursing Experience in a Medical Group, Hospital, Health Plan or Risk Based MSO setting.
Experience with Medicare/Medicare Advantage Plans, Commercial Plans, HMO, and/or Medi-Cal/ACA standards.
Must have 2 to 3 years of Quality or Peer review responsibility.
Bachelor’s degree in a health care related field preferred.

License Required

Registered Nurse (RN) in the State of California

License Preferred

N/A

Certifications Required

N/A

Certifications Preferred

N/A

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Refine Your Search

rn hoag jobs

Quality Review RN : Hospice

Clinical Nurse I: Irvine Cancer Outpatient Treatment Center

Program Manager Nursing Education and Magnet Coordinator (RN): Nursing Education

Clinical Nurse II: CCU

Clinical Nurse II: Chemical Dependency

Director Patient Care Services : Hoag at Home Administration

Clinical Nurse II: Irvine Dermatology Oncology

Clinical Nurse III : Heart Catherization Lab

Clinical Nurse Navigator I (RN) : Pain Management

Patient Care Assistant/Certified Nurse Assistant (CNA) - Medical/Surgical & Telemetry

Clinical Nurse II: Medical Oncology Specialty Clinic

Director Clinical Transplant Services : Abdominal Transplant Administration

Clinical Nurse II: Medsurg - 3 East-Brain & Spine Unit

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