RN- Clinical Quality Reviewer - Nurse, Senior
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Your Role
The Clinical Quality Review (CQR) team is responsible for reviewing potential quality of care issues (PQIs) reported by a member, a member representative, or an internal or external partner.
The Clinical Quality Reviewer – Nurse, Senior will report to the Manager, Clinical Quality Review.
In this role you will be responsible for understanding workflows, procedures, and Blue Shield of California policies to support the technical, cultural and process changes necessary for the Medicare, Commercial and Medi-Cal lines of businesses (LOBs).
In collaboration with our medical directors, you will follow up / report results to the appropriate committees for further resolution.
You will work with a clinical team comprised of Registered Nurses (RNs), physicians and administrative staff to ensure operational compliance with timeliness and reporting requirements.
You will use your clinical expertise to investigate quality of care issues related to health care concerns.
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially.
We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
About BSC
Nonprofit California health plan providing insurance coverage to individuals, families, employers, and public-program members.
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