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Senior Clinical Quality Nurse
Oscar Health. Perform quality audits on clinical documentation for clinicians from a variety of clinical departments .
About the role
Key responsibilities & impact- Perform quality audits on clinical documentation for clinicians from a variety of clinical departments
- Develop audit surveys and rubrics supporting evidence-based clinical decision making, department workflows, and regulatory accreditation requirements
- Pull clinician and provider cases for auditing and track results in department systems
- Support organizational readiness and preparation for NCQA and other regulatory audits
- Perform delegate oversight audits, write audit result summary reports, and present findings to stakeholders and delegates
- Collaborate with leadership to develop corrective action plans addressing identified gaps
- Provide 1:1 feedback and coaching to front-line staff and leaders regarding workflows and audit requirements
- Develop training tools on quality best practices, audit standards, and related topics
- Collaborate with leadership and stakeholders on audit trends, process changes, and training development
- Deliver quality-oriented presentations and aggregate quality data to report performance trends
- Participate in audit calibration sessions and interrater reliability processes
- Comply with applicable laws and regulations
- Perform other duties as assigned
Requirements
What you’ll need- Licensed Registered Nurse with active, unrestricted license in state of residence
- Willingness to obtain additional licenses as needed for Oscar’s growth, with Oscar’s support
- 2+ years of experience as a Registered Nurse
- 2+ years experience working in a clinical care setting
- 1+ years of utilization review experience at 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
Comp & perks- Employee benefits
- Unlimited vacation program
- Annual performance bonuses
- Medical benefits
- Dental benefits
- Vision benefits
- 11 paid holidays
- Paid sick time
- Paid parental leave
- 401(k) plan participation
- Life insurance
- Disability insurance
- Paid wellness time
- Wellness reimbursements