The Quality Assurance Nurse is responsible for case management quality assurance
and mentorship of operations staff, providing tools and calibrating processes,
while ensuring consistent delivery of CorVel’s case management services.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
Develop, implement, and provide ongoing quality assurance calibration of
processes as well as a case management mentoring, 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
As applicable, provide oversight and management of URAC compliance and
renewals
Work with executive, general and case management department management to
ensure the case management department successfully implemented and is
adhering to CorVel standards (including quality assurance, reporting, and
management processes)
Work closely with new hires to ensure consistent and full
integration/training of all case management managers to CorVel standards as
well as training for system usage pertaining to case management and reporting
Identify developmental needs and and participate in training of case
management leadership, including the training/re-training of all offices on
standards and procedures, and usages of the CorVel case management and
reporting system
Develop, run and interpret management reports to ensure the case management
operations are utilizing the tools available to manage compliance of services
delivery within company standards
Facilitate peer-to-peer quality reviews to ensure delivery of quality case
management
Review results and outcomes with general management and case management
leadership and develop action plans where warranted
Make recommendations in collaboration with field operations to ensure actions
toward improvement are identified
Develop and oversee case management manager mentor program to facilitate the
onboarding of new supervision and management to equip field with the tools
for compliance and consistency of CorVel standards and procedures
Implementation, oversight and communication of regulatory requirements within
case management services to include, state, federal and URAC
Identify trends and recommend action plans to management for continuous
process improvement
Ability to travel up to fifty percent of the time
Additional duties as assigned
KNOWLEDGE & SKILLS:
Excellent oral and written communication skills
PC literate, including Microsoft Office (Word, Excel)
Strong knowledge of clinical and case management processes
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 remain poised in stressful situations and
communicate using diplomacy
Ability to manage multiple complex projects and competing priorities while
working under pressure to meet deadlines and maintaining strong customer
service orientation
Effective quantitative and analytical skills
Must have strong organizational skills
Ability to work independently or in a team environment while functioning as
an educator rather than an auditor
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/Associates degree
(Bachelor of Science degree or Bachelor of Science in Nursing preferred)
3 or more years of recent clinical experience, preferably in rehabilitation
National certification (CRC, CIRS, CCRN, CVE, CCM, etc.), CCM preferred
Four year degree from an accredited college or university preferred
Certified Trainer and/or Quality Assurance distinction preferred
Four (4) years of case management experience preferred or equivalent
experience
Prior quality assurance and/or training a plus
Current RN licensure
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: $61,053 – $98,334
A list of our benefit offerings can be found on our CorVel website: CorVel
Careers | Opportunities in Risk Management
[https://www.corvel.com/company/careers/]
In general, our opportunities will be posted for up to 1 year from date of
posting, or until we have selected candidate(s) to fulfill the opening,
whichever comes first.
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 enable 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.
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