Provider Quality Review Nurse, RN

What You Can Expect

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

About the Role

The Provider Quality Review Nurse, RN reports to the Manager of Provider Quality Oversight. This role involves:

• Receiving and researching all PQI and QR cases as assigned
• Providing a summary and recommendations to the Medical Director
• Effectuating all action items as determined by the Medical Director to resolution of case assignments
• Reviewing escalated issues
• Discussing and reviewing cases with Medical Directors referred to the Quality Management (QM) department
• Investigating cases, including documenting case summaries, follow-up actions, outreach efforts, and communications in the QM database

Commitment to Quality

The IEHP Team is committed to incorporating IEHP’s Quality Program goals, including HEDIS, CAHPS, and NCQA Accreditation.

Pay, Schedule, Benefits

Competitive salary.
Hybrid schedule.
CalPERS retirement.
State of the art fitness center on-site.
Medical Insurance with Dental and Vision.
Life, short-term, and long-term disability options.
Career advancement opportunities and professional development.
Wellness programs that promote a healthy work-life balance.
Flexible Spending Account – Health Care/Childcare
CalPERS retirement
457(b) option with a contribution match
Paid life insurance for employees
Pet care insurance

Education & Requirements

Three (3) or more years of any individual or combined healthcare experience in quality assurance, quality management, quality improvement, utilization management, discharge planning, and/or case management
Three (3) or more years of work experience in a managed care, hospital, provider practice, or other comparable healthcare experience
Experience preferably in a quality/performance improvement setting
Bachelor's degree in Nursing from an accredited institution required
In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position
This experience is in addition to the minimum years listed in the Experience Requirements above
Certified Professional in Healthcare Quality (CPHQ), Certified Professional in Healthcare Risk Management (CPHRM), or Clinical certification in area specialty preferred
Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required

Key Qualifications

• Must have a valid California Driver's License
• Excellent understanding of performance improvement, quality assurance, and utilization management
• Knowledgeable in clinical analysis of health records, assessing or evaluating quality, and identifying problems or issues with care delivery
• Microcomputer applications: spreadsheet, database, and word processing
• Excellent written and verbal communication skills
• Excellent coordination skills
• Ability to communicate findings and form recommendations based on clinical case reviews
• Ability to demonstrate critical thinking, strong problem-solving capability. Strong attention to detail
• Ability to prioritize work to ensure adherence to project deadlines. Ability to effectively escalate issues as identified, following established protocols
• Positive attitude and ability to work in a team setting
• Self-direction and ability to work with minimal supervision
• Word processing and data entry involving computer keyboard and screens, automobile travel within the Inland Empire

Position Details

This position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval

Start Your Journey

Apply TODAY!