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Registered Nurse - Quality Review/Management Senior

Woodland Hills, CA

Employment Type: Contract Position: Healthcare Job Number: 9004890

Investigates and reviews potential quality of care issue (PQI) allegations or concerns arising from member grievances and internal referrals

Prepares cases on-line using department database per departmental protocols. 

• Presents PQI case review summaries/finding to Medical Director at weekly Case Review Meetings as appropriate.

• Prepares and follows case for subsequent multi-level reviews as needed. This can include review by a specialty reviewer, Peer Review Committee (PRC) or Credentialing Committee.

• Drafts corrective action plan (CAP) requests and educational letters for Medical Director to be sent to providers based on quality findings. Presents CAP responses to Medical Director and/or PRC.

• Completes special tasks or projects as assigned.

• Is able to function independently with minimal oversight and direction.

• Responsible for assignments which range from routine to complex in scope.  

Unrestricted CA RN license.

General acute care nursing experience or related.  

Alana Klingman
Strategic Accounts Recruiting Manager

Alana is a native Huntington Beach resident making the move to Sacramento just a few years ago. She comes with over 15 years of experience in full cycle healthcare recruiting and thoroughly enjoys every aspect of her job. Receiving a new client order and placing a qualified applicant is truly an excitement each and every time. Her goal at the end of every day is to leave a positive impression with everyone she works with including letting the candidates know that she is on their side. She strives to fill every client need that comes across her desk with a candidate that can call that place of business HOME. When she is not hard at work Recruiting, Alana spends her free time attending local family events, trying new eateries and perfecting DIY home projects she found on Pinterest.

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