About the job
Job Title: Remote Quality Review RN
**MUST HAVE A COMPACT AND CA License!**
Pay: $36/hour
Description: This role supports an internal team and involves conducting quality reviews of physician case reviews. The position is remote, and equipment will be provided.
Schedule:
- Monday – Friday 8-4:30pm MT, rotating weekends (40 hours per week_
Contract Details:
- W2 ongoing contract (benefits available)
- Possible Temp to Perm based on company work volume and contractor performance (no guarantee)
Qualifications:
- Active Compact/Multistate RN License
- CA RN License
- Minimum 4 years of RN experience in a clinical setting with a broad scope of practice
- Hospital bedside nursing experience in ICU, ER, M/S, or Dialysis (not OR, Peds, L&D, Women’s services, etc.)
- No travel RNs unless they have worked permanently at a hospital for 3+ years
- No NPs, whether practicing or not
- Utilization Review experience is helpful but not required; critical thinking skills are more important
- Strong computer skills required; candidates will use three monitors and multiple web-based systems
- Experience with Milliman or Interqual is a plus
- Training is approximately 2 months; candidates should not need extended time off during the first three months
Job Summary: The nurses on this team handle cases from a wide range of topics, including prenatal testing, cause-of-death cases, surgical procedures, genetic testing, and oncology. They need to be problem solvers who can apply their skills to new and slightly different problems.
Responsibilities:
- Complete quality audits of physician case reviews using national medical guidelines (MCG, Interqual, etc.)
- Format reviews according to specific requirements
- Support the clinical aspects of the review process
- Resolve operational issues related to clinical review cases
- Communicate with assigned reviewers and treating/ordering practitioners/providers
- Provide guidance to reviewers on operational aspects of review cases
- Collaborate with the Chief Medical Director and Director of Provider Relations to address reviewer quality issues
- Maintain or exceed the established monthly production benchmark