Clinical Excellence Registered Nurse

Imagine360 is seeking a Clinical Excellence RN to join the team! The Clinical Excellence Registered Nurse (RN) is a licensed professional who applies the full nursing process-assessment, diagnosis, planning, implementation, and evaluation to advance clinical quality, patient safety, and regulatory compliance across the organization to ensure high-quality, member-centered care. The role involves conducting independent audits and analysis of clinical documentation and telephonic interactions, leading interdisciplinary quality initiatives, collaborating with departmental leaders to drive performance improvement, and overseeing licensure and credential compliance.

Position Location: 100% remote

Responsibilities include but are not limited to:

Clinical Auditing and Quality Assurance

• Independently conduct comprehensive audits of clinical documentation, care coordination activities, and telephonic interactions to assess compliance with internal protocols, regulatory standards, and accreditation requirements.
• Utilize clinical judgment to identify patterns, variances, and opportunities for improvement in care delivery/documentation and use data to develop initiatives to drive change and improve quality of care within the organization.
• Provide constructive feedback and coaching to clinical staff to enhance adherence to best practices and standards of care.
  
  
  

Interdepartmental Collaboration and Leadership

• Serves as a clinical liaison between the Clinical Excellence Department and various operational units including case management, utilization management, disease management, and telephonic triage.
• Lead and participate in cross-functional teams to develop and implement quality improvement initiatives aimed at enhancing patient outcomes and operational efficiency.
• Facilitate the development and revision of clinical policies, procedures, and standard operating protocols to ensure alignment with current evidence-based practices.
  
  
  

Program Development and Education

• Collaborate with the Clinical Excellence trainer to facilitate the delivery of educational programs and training sessions to promote Clinical Excellence and continuous professional development among nursing staff.
• Mentor and support nursing staff and the application of the nursing process, critical thinking skills, and clinical practice.
• Evaluate the effectiveness of educational interventions and modify programs based on feedback and outcomes.
  
  
  

Licensure and Credentialing Oversight

• Monitor and support the licensure and certification status of nursing staff to ensure compliance with state and federal regulations.
• Coordinate with human resources and credentialing departments to facilitate timely renewals and address any discrepancies in licensure records.
• Maintain accurate records of licensure and certification statuses and provide reports to leadership as needed.
  
  
  

Required Experience/Education:

• Current, active, and unrestricted compact Registered Nurse license. Must maintain CEU’s as required by the State Board of Nursing. Must be willing to obtain and maintain additional license(s) as required to perform the job functions of the organization.
• Bachelor of Science in Nursing (BSN) required; Master of Science in Nursing (MSN) preferred.
• CPHQ Certification preferred.
  
  
  

Experience

• Minimum of three years of clinical nursing experience in areas such as case management utilization review disease management or telephonic triage.
• Demonstrated experience and quality assurance for clinical auditing or performance improvement initiatives.
  
  
  

Skills and Abilities:

• Strong analytical and critical thinking skills with the ability to interpret complex clinical data.
• Excellent communication and interpersonal skills to effectively collaborate well with multidisciplinary teams.
• Proficiency and electronic health record systems and Microsoft Office Suite.
• Ability to manage multiple projects simultaneously and meet deadlines in a dynamic environment.
• Autonomously functions within the legal and professional boundaries defined by the nurse practice act and adheres to the standards set forth by the American Nurses Association applying advanced clinical knowledge and decision-making skills when conducting audits and data analysis.
• Strict adherence to HIPAA/PHI guidelines.
  
  
  

What can Imagine360 offer you?

• Multiple Health plan options
• Company paid employee premiums for disability and life insurance
• Parental Leave Policy
• 20 days PTO to start / 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Company paid Short & Long term Disability plus Life Insurance
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company’s diversity and inclusion initiatives
  
  
  

Want to see our latest job opportunities? Follow us on LinkedIn

Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we’ve helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today’s one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.

Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

**RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV’s submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation**