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Quality Improvement Nurse

A-Line Staffing Solutions

This is a Full-time position in Tempe, AZ posted October 5, 2021.

Now hiring for a Top Healthcare / Managed Care company in Tempe whom are in need of several experienced Registered Nurse Appeals to become a part of the team, for an onsite position. Please apply directly for consideration. 

Active: RN License Required

  • Pay Rate: $35.00-$38.00 per hour 
  • Hours:Full time – Monday – Friday 40 hour 8:00 a.m. – 5:30 p.m.

Why Apply: Company Benefits!

  • Full benefits available after 90 days: Medical, Dental, Vision, Life, Short-term Disability
  • 401k after 1 year of employment: With employer match and profit sharing
  • GREAT Hours! Full-Time Monday through Friday, 40 hours per week – Overtime available paying time and a half over 40 hours worked.
  • Competitive Pay Rate! With possible pay increases after 90 days of employment
  • Work Life Balance

Job Description:.

  • Review Utilization Management denial authorizations or/and Care Management member records to ensure compliance with appropriate standards (NCQA, CCM, company process and policies, federal and or state regulations) using standard audit tools.
  • Document audit results timely
  • Create summary finding
  • Respond to audit appeals
  • Attend meetings to discuss audit trends
  • Offer recommendations for quality improvement

Education/Experience:

  • Graduate from an Accredited School of Nursing.
  • Bachelor’s degree in Nursing preferred
  • Current state’s RN license.
  • 0-2 years of experience

Required:

  • Case Management (Medicare/Medicaid/MarketPlace) or Case Management/ NCQA
  • Utilization Management/ Application of Medical Necessity Criteria (Prior Authorization, and Concurrent Review)
  • Business documentation acumen
  • Moderate to Intermediate use of Excel functions
  • NCQA Audit Experience
  • Advanced verbal and written communication skills

Managed Care, Health Plan, Health Insurance, Case Manager, Care Manager, Utilization Review, Utilization Management, STARS, HEDIS, Complex Case Management, CCM, Certified Case Manager, NCQA, URAC, CMS, Medicare, Medicaid, HMO, RN, BSN, MSN, Registered Nurse, Quality Assurance, Quality Improvement