Registered Nurse-Utilization Review

Description Job Opportunity: Registered Nurse - Utilization Review Facility: CSMN - 8714024 - MNS Quality Management Location: Los Angeles, CA Employment Type: Travel/Contract Shift: Day (5x8 Hours) 8:00 17:00 Start Date: 2/24/2025 Job Duration: 13 weeks Compensation: Rate Type: Hourly Over Time: Default Multiplier: None; 8 Hour Multiplier: 40 total hours in 1 week: 1.3%; 10 Hour Multiplier: 40 total hours in 1 week: 1.3%; 12 Hour Multiplier: 48 total hours in 1 week: 1.3%; Double Time: 12 total hours in a day: 1.7% On-Call: 8$ Call Back: 1% Holiday Pay: 1.5% Additional Information: Hybrid/Remote within a commutable distance to Beverly Hills/Los Angeles Required: * CA RN License * 2 years of statistical/data analytic experience * Experience in quality improvement or process improvement * BLS Preferred: * BSN * Prior work in an ambulatory healthcare setting * ACLS Primary Duties and Responsibilities • Review occurrence reports and the related pertinent medical records to determine opportunities for quality improvement. Assist in evaluating incidents that require review and perform root cause analysis. • Aggregate and clinically analyze quality metric data in support of Medical Directors/Chairs of the specific departments. • Perform outpatient case review of hospitalizations related to re-admissions and sentinel diagnoses, and identify opportunities for care improvement. • Serve on Quality Improvement Committees. Support HEDIS, pay-for-performance, ACO and other clinical pay-for-performance and pay-for-value program. • Perform clinical site reviews and/or medical record reviews as directed in support of health plan and/or other regulatory/accreditation/compliance requirements • Perform chart abstraction and analysis of root causes, presentation of cases for review with physician panel, discussion of opportunities for care improvement, communication to relevant stakeholders, and follow-up on specific issues • Perform in-depth analysis of individual cases as well as trend analysis across the entire population of patients • Create clinical quality and value dashboards and action reports in support of performance improvement activities. Develop slide decks and other communication tools and make periodic presentations to share trend information with key stakeholders. • Participate in Performance Improvement activities to design and implement quality improvement initiatives, including those for Population Health and Patient Engagement. • Create clinical quality and value dashboards and action reports in support of performance improvement activities. • Assist in preparing for and responding to accreditation and regulatory agencies or surveys • Performs other duties as assigned.