About the position
Responsibilities
• Ensure the highest quality processes and activities are performed by the G&A clinical staff.
• Assist in the development of quality initiatives and develop & implement the clinical QA Plan.
• Perform standardized monitoring and auditing within the G&A department.
• Develop and utilize quality auditing tools and summarize audit findings.
• Identify training needs for the G&A clinical staff.
• Identify Continuous Improvement opportunities through QA and LEAN activities.
• Ensure compliance with regulatory standards, practices, and guidelines.
• Lead and track Continuous improvement projects within the department.
• Support quality assurance efforts related to appropriate Grievance case categorization.
Requirements
• Two (2) or more years of experience as an RN in case management, utilization management in managed care setting or related experience in a health care delivery setting.
• Two (2) or more years of experience as an RN in clinical nursing in a hands-on patient care delivery setting.
• Two (2) or more years of experience relevant to Grievance & Appeals case review.
• Associate's degree in nursing from an accredited institution required.
• Minimum possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California Board of Registered Nursing required.
Nice-to-haves
• Bachelor's degree in nursing from an accredited institution preferred.
Benefits
• Competitive salary
• 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
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance
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