QIA Nurse Specialist (RN) (PQI)

About the role

We are seeking a QI Nurse Specialist (RN) (PQI) to join our quality improvement team in a full telework capacity within California.

Responsibilities

• Conduct clinical assessments of member complaints and urgent issues, supporting high-quality, member-centered care.
• Participate in handling quality of care grievances and investigations for potential quality issues, ensuring compliance with regulations and policies.
• Develop thorough clinical review reports, collect appropriate data, and facilitate case closure with medical and organizational leadership.
• Maintain departmental database integrity through accurate case documentation and participate in meetings, training, and audits.
• Foster a culture of compliance, ethics, and continuous improvement.

Requirements

• California RN license.
• Bachelor’s degree in nursing.
• At least 5 years of patient care experience, including 2 years in acute care.
• Preferred certifications: CCM or CPHQ.
• Experience in managed care and project management are advantageous.
• Strong communication, analytical, problem-solving, and relationship-building skills.
• Ability to work independently in a fast-paced environment.
• Proficiency in computer software such as Microsoft Office and relevant systems.
• Ability to read and communicate clearly, lift objects up to 25 pounds, and adapt to a flexible schedule.
• Access to transportation for occasional work outside primary location.

Benefits

• Competitive salary.
• Full telework eligibility.
• Comprehensive benefits.
• Retirement plans.
• Paid time off (PTO).
• Wellness programs.
• Tuition reimbursement.
• Professional growth opportunities.