Senior Clinical Quality Nurse

This is a fully remote position, open to applicants in Arizona, +15 more states.

📋 Description

• Conduct quality audits on clinical documentation for healthcare professionals across various clinical departments.

• Create audit surveys and rubrics that facilitate evidence-based clinical decision-making, enhance department workflows, and ensure compliance with regulatory accreditation standards.

• Retrieve clinician and provider cases for auditing purposes and document results within departmental systems.

• Assist the organization in preparing for NCQA and other regulatory audits.

• Execute oversight audits for delegates, compile audit result summary reports, and present findings to stakeholders and delegates.

• Work collaboratively with leadership to formulate corrective action plans that address identified deficits.

• Offer one-on-one feedback and coaching to frontline staff and leaders concerning workflows and audit expectations.

• Create training materials focused on quality best practices, audit standards, and related subjects.

• Partner with leadership and stakeholders to analyze audit trends, implement process changes, and develop training programs.

• Provide quality-focused presentations and compile quality data to highlight performance trends.

• Engage in audit calibration sessions and processes to ensure interrater reliability.

• Adhere to all relevant laws and regulations.

• Undertake additional duties as assigned.

⛳️ Requirements

• Licensed Registered Nurse with an active, unrestricted license in the state of residence.

• Willingness to obtain further licenses as required for Oscar’s expansion, with support from Oscar.

• A minimum of 2 years of experience as a Registered Nurse.

• At least 2 years of experience in a clinical care environment.

• Over 1 year of experience in utilization review within a managed care plan or provider organization.

• Must reside in Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Michigan, Missouri, Nebraska, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, or Virginia.

🏝️ Benefits

• Comprehensive employee benefits.

• Unlimited vacation program.

• Annual performance bonuses.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 11 paid holidays.

• Paid sick time.

• Paid parental leave.

• Participation in a 401(k) plan.

• Life insurance.

• Disability insurance.

• Paid wellness time.

• Wellness reimbursements.