|Published||November 21, 2022|
|Category||Nurse - Quality|
Please get in touch for all the information relating to this fantastic opportunity!
Extremely competitive salary range!
We welcome 100% remote work for residents of SW Washington and Oregon.
- Responsible for the completion of Quality monitoring and chart abstraction audits. Quality audits include but are not limited to: patient health information, clinical testing and follow-up, quality of provider services and medical management, medical record requirements, and other quality requirements as defined by PHP, performance measurement specifications, or Federal and State regulations
- Be able to investigate perceived gaps in care identified through claims in order to identify documentation necessary to support exclusions or numerator hits
- Use claims information to track where member has received care
- Adhere to a tight schedule of pre-scheduled clinic visits combined with in-office reviews
- Conduct clinical reviews using medical record/medical information
- Use audit tools, conduct auditor training, perform tool validation, and conduct audits
- Work with analytical staff to develop and maintain effective databases and reporting. Work with quality team to assure documentation is audit-ready
- Identify concerning care patterns by use of audits and audit reports
- Understand and communicate to practices basic specifications around HEDIS or other clinical measures being audited
- Maintain the confidentiality of all provider and member health data and information. Maintain data integrity with highest degree of accuracy and documentation requirements per PHP's auditor
- Perform Clinical Onsite Provider Record audits to assure and document on a template, appropriate and current standards are in place for access, patient care facilities and medical record standards
- Design and compile periodic monitoring reports including program evaluation and identification of improvement opportunities
Required qualifications for this position include:
- Degree in Nursing
- 5 years of Clinical Experience
- Oregon Registered Nurse Licensure
Preferred qualifications for this position include:
- Bachelor's Degree in Nursing
- 1 year Quality management/quality improvement/utilization review auditing experience, including experience in auditing within electronic health records
- Experience with health plans, project management, program evaluation, team facilitation, data analysis, and/or case review
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
Degree in Nursing
5 years of Clinical Experience
Oregon Registered Nurse Licensure