Clinical QA Nurse Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Intake, triage, track, and respond to clinical review requests, escalations, and inquiries in line with established service level agreements (SLAs).

• Analyze patient medical records, extracting pertinent clinical information for presentation to providers and leadership as necessary.

• Investigate and resolve clinical escalations that arise from members and internal stakeholders.

• Address member inquiries in accordance with Vida clinical guidelines and program requirements.

• Collaborate with Providers, Clinical Assistants, and cross-functional teams to ensure continuity of care and address member concerns.

• Monitor cases until resolution, ensuring timely follow-up and documentation.

• Contribute to quality assurance initiatives by identifying trends, opportunities for process improvement, and potential member safety issues.

• Assist with provider performance monitoring, quality reviews, and operational audits as needed.

• Maintain accurate, complete, and timely documentation within the required systems.

• Utilize provider messaging platforms, templates, workflows, and telehealth technologies.

• Perform duties within the scope of practice and in alignment with Vida clinical guidelines.

• Take on additional responsibilities as required.

⛳️ Requirements

• Active RN or LPN license in good standing.

• At least 2 years of experience in primary care, family medicine, internal medicine, or an outpatient clinical setting.

• Proficient in reviewing medical records and clinical documentation.

• Strong written and verbal communication abilities.

• Exceptional organizational skills and attention to detail.

• Proven capability to analyze situations, identify issues, and implement effective solutions.

• Ability to work independently and efficiently in a fully remote environment.

• Strong proficiency in computer and technology skills.

• Proficient in utilizing cloud-based technologies such as Slack, Google Workspace, Zendesk, Zoom, electronic medical records, and telehealth platforms.

• Capable of navigating multiple systems simultaneously while maintaining accuracy and efficiency.

• Demonstrated ability to manage multiple priorities in a fast-paced environment.

• Commitment to providing compassionate, patient-centered support.

• Ability to adapt to changing workflows, technology platforms, and operational processes.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance.

• Flexible work hours and remote work options.

• Opportunities for professional development and continuing education.

• Supportive and collaborative work environment.