HIRING!! Awesome Job Opportunity as a Quality Management Nurse Consultant for CVS Health
We, at Medical Recruitment Strategies is looking for the best Quality Management Nurse Consultant for CVS Health
Job Title: Quality Management Nurse Consultant
Job Period: March 20, 2023 - June 17, 2023
Job Location: Remote/Work from Home
Shift: Monday-Friday 8AM - 5PM
Pay Rate: $33.78/HR
As a Quality Management Nurse Consultant, your key responsibilities would include but are not limited to:
- Responsible for the review and evaluation of clinical information and documentation.
- Reviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues.
- Independently coordinates the clinical resolution with internal/external clinician support as required.
- Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines.
- Accurately applies review requirements to assure case is reviewed by a practitioner with clinical expertise for the issue at hand.
- Commands a comprehensive knowledge of complex delegation arrangements, contracts, clinical criteria, benefit plan structure, regulatory requirements, company policy and other processes which are required to support the review of the clinical documentation/information.
- Pro-actively and consistently applies the regulatory and accreditation standards to assure that activities are reviewed and processed within guidelines.
- Condenses complex information into a clear and precise clinical picture while working independently.
- Reports audit or clinical findings to appropriate staff or others in order to ensure appropriate outcome and/or follow-up for improvement as indicated.
Experience / Qualification required:
- Active and in good standing RN License in Pennsylvania
- 10 years of RN clinical experience required- Managed Care, ER, UM, med-surg experience preferred
Please submit your most recent resume together with time of availability and updated contact number for a brief interview. Thank you!