Job Description
Clinical RN Quality ReviewerSchedule: M-F, 8a-5pMust reside in either TX, NM, CO or WY
Position Overview
Primarily responsible for conducting post-service in-depth clinical reviews in accordance with accepted standards of care. Works independently and with other departments and/or vendors to ensure clinical potential quality issues are tracked, investigated, and resolved in accordance with plan requirements. The overall goal is to improve clinical service delivery and organizational processes.
Essential Job Duties
Utilizes clinical expertise to conduct clinical case retrospective reviews to determine deviation from standard of care or gaps in care and presence of mandatory data elements
Identifies clinical quality issues as evidenced by deviation from accepted standard of practice or gap in care
Documents progress of audits and findings in internal databases and/or Excel spreadsheets
Conducts clinical literature and regulatory standards reviews and summarizes findings
Contacts providers/facilities, as applicable, to obtain information and/or medical records needed to conduct a comprehensive clinical review of cases
Conducts chart reviews and audits both electronic and at medical facilities
Writes succinct and targeted investigative summaries
Travels to new sites to assist with start-up initiatives if needed
Maintains positive working relationships with internal and external clinical/administrative personnel
Maintains confidentiality of all medical records, correspondence, and related documents
Effectively meets strict deadlines
Participates in collection and analysis of data for clinical statistical reports (i.e., monthly quality issue report, and annual clinical quality management program report)
Participates in collection, analysis, and presentation of data for Peer Review, Credentials Review and Quality Committees. Continuous Quality Improvement
Provides essential support in accreditation endeavors by managing data collection, tracking progress, and ensuring organization.
Attends meetings to achieve departmental/organizational goals and objectives
Ability to recommend corrective actions and/or sanctions
Manages assigned caseload in accordance with established performance metrics
Performs other duties as assigned or required
Minimum Education/Experience Requirements
Current and unrestricted state RN license
Quality management certification preferred
Minimum 5 years of healthcare quality management experience and minimum 5 years clinical nursing experience.
Quality assurance/improvement experience in a health care accreditation or regulatory agency.
Experience in CorEMR a plus.
Additional Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Competencies
Clear and effective verbal and written communication with all coworkers, supervisors, jail administration, and patients
Excellent verbal and written comprehension
Excellent deductive reasoning and problem-solving abilities
Excellent organizational skills
Ability to use a computer and use/learn a variety of software, including site-specific computer programs
Ability to respect the dignity and confidentiality of inmates
Employment Requirements
Must maintain all certifications, educational requirements, licensing, etc. for this position
Must have current CPR/BLS certification
Must have current TB test (taken within one year)
Must adhere to all facility policies and procedures as well as the policies and procedures listed in the Team Member Handbook
Willing to assist coworkers in the job duties and work overtime if required; may act as a resource to other coworkers
Maintains confidentiality, dignity, and security of health records and protected health information in compliance with HIPAA requirements
Security Requirements
Must undergo security training and orientation on facility safety policies and procedures
Physical/Mental Requirements
This position routinely requires (but is not limited to) the following:
Ability to both remain stationary and move/traverse throughout the facility, including up and down flights of stairs
Ability to position oneself in different spaces
Ability to convey and discern information in a conversation, frequently communicate with patients; must be able to exchange accurate information.
Ability to identify and detect objects and assess situations from a variety of distances
Ability to stay calm in stressful and demanding situations
Frequently transports objects up to 50 pounds
Work Environment
This position consists primarily of remote work, complemented by duties within a correctional facility. While performing on-site tasks, employees may encounter certain risks, including exposure to bloodborne pathogens, inherent in the correctional environment. To ensure safety, employees are expected to diligently adhere to all security protocols and regulations. This approach is designed to mitigate risks, safeguarding both the individual and their colleagues.
Correctional Nurse / Correctional Healthcare / Correctional Nursing / Corrections / County Corrections / Corrections Nurse / Corrections Healthcare / Correctional Medicine / Forensic Nursing / Jail Nursing
Other
Employee must comply with all current and future State, Federal, and Local laws and regulations, court orders, Administrative Directives and standards and policies and procedures of the site where assigned, including those of professional organizations such as ACA, NCCHC, etc.Employee must treat every other member of the CorrHealth team, all correctional personnel, all inmates and third parties in the facility with the proper dignity and respect. Actions or communications that are inappropriate or degrading will not be tolerated.
Position Overview
Primarily responsible for conducting post-service in-depth clinical reviews in accordance with accepted standards of care. Works independently and with other departments and/or vendors to ensure clinical potential quality issues are tracked, investigated, and resolved in accordance with plan requirements. The overall goal is to improve clinical service delivery and organizational processes.
Essential Job Duties
Utilizes clinical expertise to conduct clinical case retrospective reviews to determine deviation from standard of care or gaps in care and presence of mandatory data elements
Identifies clinical quality issues as evidenced by deviation from accepted standard of practice or gap in care
Documents progress of audits and findings in internal databases and/or Excel spreadsheets
Conducts clinical literature and regulatory standards reviews and summarizes findings
Contacts providers/facilities, as applicable, to obtain information and/or medical records needed to conduct a comprehensive clinical review of cases
Conducts chart reviews and audits both electronic and at medical facilities
Writes succinct and targeted investigative summaries
Travels to new sites to assist with start-up initiatives if needed
Maintains positive working relationships with internal and external clinical/administrative personnel
Maintains confidentiality of all medical records, correspondence, and related documents
Effectively meets strict deadlines
Participates in collection and analysis of data for clinical statistical reports (i.e., monthly quality issue report, and annual clinical quality management program report)
Participates in collection, analysis, and presentation of data for Peer Review, Credentials Review and Quality Committees. Continuous Quality Improvement
Provides essential support in accreditation endeavors by managing data collection, tracking progress, and ensuring organization.
Attends meetings to achieve departmental/organizational goals and objectives
Ability to recommend corrective actions and/or sanctions
Manages assigned caseload in accordance with established performance metrics
Performs other duties as assigned or required
Minimum Education/Experience Requirements
Current and unrestricted state RN license
Quality management certification preferred
Minimum 5 years of healthcare quality management experience and minimum 5 years clinical nursing experience.
Quality assurance/improvement experience in a health care accreditation or regulatory agency.
Experience in CorEMR a plus.
Additional Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Competencies
Clear and effective verbal and written communication with all coworkers, supervisors, jail administration, and patients
Excellent verbal and written comprehension
Excellent deductive reasoning and problem-solving abilities
Excellent organizational skills
Ability to use a computer and use/learn a variety of software, including site-specific computer programs
Ability to respect the dignity and confidentiality of inmates
Employment Requirements
Must maintain all certifications, educational requirements, licensing, etc. for this position
Must have current CPR/BLS certification
Must have current TB test (taken within one year)
Must adhere to all facility policies and procedures as well as the policies and procedures listed in the Team Member Handbook
Willing to assist coworkers in the job duties and work overtime if required; may act as a resource to other coworkers
Maintains confidentiality, dignity, and security of health records and protected health information in compliance with HIPAA requirements
Security Requirements
Must undergo security training and orientation on facility safety policies and procedures
Physical/Mental Requirements
This position routinely requires (but is not limited to) the following:
Ability to both remain stationary and move/traverse throughout the facility, including up and down flights of stairs
Ability to position oneself in different spaces
Ability to convey and discern information in a conversation, frequently communicate with patients; must be able to exchange accurate information.
Ability to identify and detect objects and assess situations from a variety of distances
Ability to stay calm in stressful and demanding situations
Frequently transports objects up to 50 pounds
Work Environment
This position consists primarily of remote work, complemented by duties within a correctional facility. While performing on-site tasks, employees may encounter certain risks, including exposure to bloodborne pathogens, inherent in the correctional environment. To ensure safety, employees are expected to diligently adhere to all security protocols and regulations. This approach is designed to mitigate risks, safeguarding both the individual and their colleagues.
Correctional Nurse / Correctional Healthcare / Correctional Nursing / Corrections / County Corrections / Corrections Nurse / Corrections Healthcare / Correctional Medicine / Forensic Nursing / Jail Nursing
Other
Employee must comply with all current and future State, Federal, and Local laws and regulations, court orders, Administrative Directives and standards and policies and procedures of the site where assigned, including those of professional organizations such as ACA, NCCHC, etc.Employee must treat every other member of the CorrHealth team, all correctional personnel, all inmates and third parties in the facility with the proper dignity and respect. Actions or communications that are inappropriate or degrading will not be tolerated.
💡 Quick Summary
Seeking a career-building opportunity? The Clinical RN Quality Reviewer- job post position is now open for candidates interested in the IT Engineer & Developer Jobs sector. This role in Dallas offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in IT Engineer & Developer Jobs is a plus.