DEPARTMENT(S): Quality Improvement REPORTS TO: Supervisor, Quality Improvement (PQI) FLSA STATUS: Non-Exempt SALARY GRADE: M - $40.87 - $63.99 ($85,000 - $133,100)
PARTIAL TELEWORKTHIS POSITION IS A PARTIAL REMOTE OPPORTUNITY FOR SOUTHERN CALIFORNIA APPLICANTS. IN ORDER TO BE CONSIDERED, YOU MUST LIVE IN SOUTHERN CALIFORNIA OR BE WILLING TO RELOCATE.
JOB SUMMARY:
The QI Nurse Specialist-Potential Quality Issue (PQI) is responsible for participating in managing the organization's clinical grievance review process including investigation of all quality reviews for potential quality of care concerns. The incumbent will be involved with the collection of appropriate data and closing cases by preparing and submitting the cases to the appropriate physician reviewer and committees for closure. The incumbent ensures grievances/complaints are processed in accordance with regulations, compliance standards and policies and procedures.
POSITION RESPONSIBILITIES:
POSSESSES THE ABILITY TO:
EXPERIENCE & EDUCATION:
PREFERRED QUALIFICATIONS:
KNOWLEDGE OF:
CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics._ _
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Required Skills Required Experience