The Quality Assurance Nurse is responsible for case management quality assurance and mentorship of operations staff, providing tools and calibrating processes, while ensuring consistent delivery of CorVel's case management services.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES
- 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
- Additional duties as assigned
KNOWLEDGE & SKILLS
- Excellent oral and written communication skills
- PC literate, including Microsoft Office (Word, Excel)
- Strong knowledge of clinical and case management processes
- Strong knowledge and experience in quality assurance and training programs
- Proficient in identifying case management office improvement opportunities and communicating and implementing solutions
- Ability to remain poised in stressful situations and communicate using diplomacy
- Ability to manage multiple complex projects and competing priorities while working under pressure to meet deadlines and maintaining strong customer service orientation
- Effective quantitative and analytical skills
- Must have strong organizational skills
- Ability to work independently or in a team environment while functioning as an educator rather than an auditor
- Knowledge of the entire claims administration, case management and cost containment solution as applicable to third party administrator operations
EDUCATION & EXPERIENCE
- 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
Pay Range: $61,053 – $98,334