Job Description

CorVel is seeking a Quality Assurance Nurse with experience in Case Management and Worker's Compensation to conduct case management quality assurance audits. The Quality Assurance Nurse Auditor (QA Auditor) will serve a key role in ensuring patient and department records and processes are in compliance with policies, quality standards, workflow procedures, and regulatory and accreditation requirements. The QA Auditor will perform quality assurance audits for quality documentation and appropriate management of processes, maintain detailed auditing records, prepare trending reports, and monitor auditing results to support continuous innovation and compliance.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

• Develop, implement and provide ongoing quality assurance audit of processes both managed and delivered at the operational level.
• Educate and equip operations with performance measurement and reporting tools that can be used to objectively measure and grow operations.
• Provide national account and regulatory quality oversight.
• Work with case management departmental management to address CorVel standards inclusive of quality assurance, reporting and processes.
• Develop, run and interpret management reports to ensure case management operations are utilizing the tools available to manage compliance of services delivery within company standards.
• Ability to review results and outcomes with general management and case management leadership while providing constructive feedback in a clear, concise, and respectful manner.
• Make recommendations in collaboration with field operations to ensure actions toward improvement are identified.
• Implementation, oversight and communication of regulatory requirements within case management services to include state and federal regulations.
• Direct quality assurance audit activities and quality improvement plans in coordination with case management team managers, to ensure compliance with both state and federal requirements.
• Conducts various types of case reviews for quality and appropriate medical management, cost containment, peer review and rehabilitation.
• Identify trends and recommend action plans to management for continuous process improvement.
• Ability to work independently while prioritizing and completing multiple complex work assignments with demonstrated ability to meet or exceed deadlines.
• Proficient and knowledgeable of quality assurance functions, quality systems, internal auditing, and/or quality improvement.
• Basic knowledge of data analysis, statistics, data integrity, and analytics with initiative and ability to further develop skills
• Performs other duties as assigned.

KNOWLEDGE & SKILLS:

• Excellent oral and written communication skills.
• PC literate, including Microsoft Office (Word, Excel).
• Strong knowledge of the clinical and case management processes.
• Knowledge of regulatory and accreditation agencies and requirements.
• Strong knowledge and experience in quality assurance and training programs.
• Proficient in identifying case management office improvement opportunities and communicating and implementing solutions.
• Ability to develop routine reports and correspondence and to present information in one-on-one, small group and large group settings.
• Ability to remain poised in stressful situations and communicate diplomatically via telephone, computer, fax, correspondence, etc.
• Effective quantitative and analytical skills.
• Must have strong organizational skills.
• Knowledge of the entire claims administration, case management and cost containment solution as applicable to third party administrator operations.

EDUCATION & EXPERIENCE:

• Graduate of accredited school of nursing with a diploma / associate degree required. (Bachelor of Science degree or Bachelor of Science in Nursing preferred)
• Four-year degree at an accredited college or university preferred.
• 3 or more years of clinical experience required.
• 2 or more years of experience in quality assurance, case management, worker's compensation or another related field required.
• National certification (CRC, CIRS, CCRN, CVE, CCM, etc.), CCM preferred.
• Certified Trainer and/or Quality Assurance distinction, a plus.
• Current, unrestricted RN licensure required.

PAY RANGE:

CorVel uses a market-based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range, and these adjustments would be clarified during the offer process.

Pay Range: $56,860 – $91,580

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

ABOUT CORVEL:

CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enables us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

Together, let’s do more.

We are a national provider of risk management solutions for the workers’ compensation, auto, health and disability management industries. We provide our clients with the information and insight they need to make smart decisions. We believe that together, we can deliver better results.

Innovation is our passion.

We invest in intelligent systems and the integrated ecosystem that keeps us all connected. Our commitment to innovation is why we are a nationwide leader in technology driven programs.

We strive for excellence.

With the right mix of savings and customer service, we effectively balance risk and reward. Our expertise and service delivery drive the results your program needs and the savings your bottom line wants.

Our purpose is care.

Every injured worker needs timely, compassionate care. We value your people and we advocate care for your employees. This purpose drives what we do together every day, which is to return injured employees to the workplace.

Job Tags

Similar Jobs