Investigative Nurse - Hybrid

Title:             Investigative Nurse - Hybrid

Mandatory skills:

risk management, quality assurance nurse, auditing,
databases, Microsoft Office products, email, electronic referral, verification sources,
Medical chart review,
Nursing Process, assessment, monitoring, evaluation,
Quality Management Unit, quality-of-care investigations, quality-of-care issues

Description:

Quality of care Investigative Nurse

This position reports to the client – Quality Management Unit and conducts quality-of-care investigations pursuant to the contract between the client system. This position participates in investigations of member-centric and systemic quality-of-care concerns to ensure member health and well-being.

Conducts timely, thorough, member centric, and systemic investigations of all division member quality-of-care issues and implements vendor-specific corrective action plans, utilizing a standardized process. Makes appropriate referrals to oversight and regulatory agencies. Participates in Care Concerns, Care Needed today, and member issues as assigned. Maintains all necessary documentation to support case work. Request appropriate documentation for quality-of-care investigations and ensure the maintenance of comprehensive case records to support allegation review and substantiation levels. As a result of the OOC Investigation, issue remediation or a Corrective Action Plan to the vendor, and ensure all applicable investigative information and documents are uploaded within the client OMS Portal. Appropriately elevates cases and/or trend concerns to the OOC supervisor.

Skills:
Critical thinking
Technological skills, including the use of databases, Microsoft Office products, email, and electronic referral and verification sources.
Producing professional technical reports and letters.
Research and analysis.
Oral and written communication skills.
Personal planning, organization, and time management.
Medical chart review.
Nursing Process, including assessment, monitoring, and evaluation.
Decision-making skills.
Critically analyze problems and develop effective plans for corrective action.

Required Education:
This position requires that the successful candidate possess and maintain an active license to practice as a Registered Nurse (RN) in AZ.

Required Skills
6 months to a year of risk management, quality assurance nurse or auditing experience
Active license as a Registered Nurse (RN) in AZ

Notes:
Hybrid. Will allow remote once training is completed
8:00 AM - 5:00 PM

VIVA USA is an equal opportunity employer and is committed to maintaining a professional working environment that is free from discrimination and unlawful harassment. The Management, contractors, and staff of VIVA USA shall respect others without regard to race, sex, religion, age, color, creed, national or ethnic origin, physical, mental or sensory disability, marital status, sexual orientation, or status as a Vietnam-era, recently separated veteran, Active war time or campaign badge veteran, Armed forces service medal veteran, or disabled veteran. Please contact us at for any complaints, comments and suggestions.

Contact Details :

Account co-ordinator: Ramadas Kumaresan

VIVA USA INC.
3601 Algonquin Road, Suite 425
Rolling Meadows, IL 60008
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