Quality Site Review RN

Location: Richmond, VA
Date Posted: 02-07-2018
Quality Facility Site Review (FSR) RN – Managed Care
Richmond, VA
* Requires travel (Vehicle Provided) around the State to conduct site visits of contracted facilities. *
** About 25% will be in the Northern Virginia / Winchester region, with 75% split among the remaining state regions. **
*** May require an occasional overnight stay (Lodging Provided). ***
Quality Site Review Nurse Summary:
  • The Quality Facility Site Review (FSR) Nurse conducts on-site visits, follow-up in-services and participates in corrective action plan completion with individual Physicians and Provider Groups for Facility Site and Medical Record Review.
  • The FSR Nurse will analyze medical charts, trend lines and applicable transparency websites in order to determine whether there are adverse trends and/or sites of excellence. 
  • Ensure that the health plan and its contracted network provide members with appropriate and timely and quality of care and services.
  • Performing quality reviews based upon pre-determined quality indicators to include data aggregation, report development and formulation of recommendations based upon results.
  • Scheduling and coordinating on-site medical record reviews for quality of care investigations.
  • Working with the quality improvement manager, director and other designated staff to identify and share best practices and opportunities for quality improvement
  • Performing on-site reviews of practitioner/facility offices, including, but not limited to evaluation of physical accessibility/appearance, adequacy of waiting and examining room space, availability of appointments, adequacy of treatment record keeping and clinical medical record reviews.
  • Educating practitioners/providers on policies and standards related to site surveys.
  • Collecting information from practitioners/providers who perform well in particular areas of their practice to serve as “Best Practice” models for other network practitioners/providers
  • Performing chart reviews for the purpose of follow-up from past fails, review of HEDIS measures against standards, and achievement of performance goals.
  • Investigating Quality of Service and Quality of Care grievances/complaints/issues from members or at the request of one of the Credentialing Committee.
Quality Site Review Nurse Profile: 
  • Valid, unrestricted state Registered Nurse (R.N.) license.
  • Prefer those certified in Facility Site Review (FSR), with around 1 year of relevant experience.
  • Clinical background with a minimum of 3 years’ experience, ideally in a managed care environment.
  • Requires 2-3 years experience in a managed care environment coordinating programs and/or seminars for providers.
  • At least 2 years performing quality reviews or previous regulatory audit experience.
  • Possess knowledge of ICD-9/10 and CPT4 coding; HEDIS experience preferred.
  • Prefer 1-3 years Quality experience, preferably with a Health Plan or Managed Care Organization (IPA/HMO/TPA, etc).
  • Possess superior verbal and written communication skills, able to interface with professionals.
  • Intermediate computer skills, at a minimum, proficient in MS Office Suite of Programs.
  • Must be willing and able to travel in-state (vehicle provided), including rare overnight stays.

443.552.7423 (CALL – TEXT – FAX)
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