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AgreeYa Solutions: Registered Nurse

AgreeYa Solutions

This is a Full-time position in Los Angeles, CA posted September 12, 2020.

Job SummaryThe Specialist RN II position manages the organization’s clinical review process for potential quality of care concerns and quality of service and access issues, including collection of appropriate data.

Closes cases by preparing and submitting the case(s) to the appropriate physician reviewer and committees for case closure.

Ensures clinical reviews are processed in accordance with regulations, compliance standards and policies and procedures.

Processes potential for client and monitors PQI’s for plan partners/delegates and presents summary of the data at Peer Review Committee.Duties/Responsibilities:Handles inquiries & resolution of clinical operational issues.

Make decisions using clinical judgment.

Develops and maintains positive working relationships with internal and external clients/ customers/members.

Participates in special projects, working with other departments and attending scheduled meetings.

Meets or exceeds deadlines.

Creates, maintains and implements training / education and supporting documentation for internal and external clients / customers / members.

Reports and tracks data in support of clinical operational goals and initiatives of the work unit /client’s annual QI work plan.

Participates in the implementation of QI initiatives.

Leads meetings and collaborates with internal organizations and external clients to resolve issues and improve processes.

Perform other duties as assigned.Experience Required:At least 5-7 years of quality improvement experience as an RN in a managed care setting preferably with Medicare or other government programs.Skills Required:Must have excellent written and verbal communication skills.

Ability to manage projects independently and assume responsibility for successful completion.

Ability to develop and maintain strong working relationships with internal and external clients/ customers /members.Licenses/Certifications Required (RN) Active, current and unrestricted California LicenseEducation RequiredAssociate’s Degree in NursingEducation PreferredBachelor’s Degree in NursingAssociated topics: care unit, intensive, intensive care unit, nurse clinical, nurse rn, psychatric, recovery, registed, transitional, unit