Quality Site Review RN

Location: Winchester, VA
Date Posted: 03-30-2018
CareNational
Quality Site Review RN – Managed Care
Winchester, VA
 
*** This is a Full-Time, Benefits Available, CONTRACT opportunity, expected to last several months, or longer! ***
 
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 Site Review 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. .
  • 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.
#CLINICAL
Erik Berg
Search Consultant

CareNational Healthcare Services
erik@carenational.com
https://www.linkedin.com/in/erikberg462/

443.470.8240 (CALL – TEXT – FAX)
CareNational.com
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