Quality Nurse Specialist - Fully Remote
Location: Kansas City
Posted on: January 16, 2022
Quality Nurse Specialist
Are you an experienced Quality Nurse Specialist looking for a new
Do you value care management and quality improvement?
Are you motivated, energetic, and excited to become part of the
If so, you might be our next new team member!
This is a fully remote position.
Who We Need
Works in conjunction with the Operations Manager of the Tricare
Contract to oversee the day to day activities of the nurse
reviewers and abstractors in assigned areas to successfully meet
contract deliverables. Assists in meeting deliverables related to
the Review Department within budgetary parameters. Supports the
operations manager with implementation and coordination of testing
and quality assurance to support the program or contract.
Identifies/plans/Coordinates/implements quality improvement
projects using knowledge of performance improvement strategies,
principles, methodology, techniques and data analysis. Uses
measurable indicators and outcome measurements to determine whether
the desired organizational results are achieved.
Kepro is a rapidly growing national quality improvement and care
management organization. We work to ensure that over 20 million
people receive the right care, at the right time, in the right
People Focused. Mission Driven.
Shape the future of healthcare with us. We are mission driven to
improve lives through healthcare quality and clinical
We do this through our people.
At Kepro, you can do meaningful work that makes a real difference
for the lives of individuals across the country. We are an
organization that cares deeply about our employees and we provide
the training and support to do the best work of your career.
Benefits are a key component of your rewards package at Kepro.
These benefits are designed to provide you and your family
additional protection, security, and support for both your career
and your life away from work. They are comprehensive and fit a
variety of needs and situations. Our benefits include comprehensive
health plans, paid time off, retirement savings, corporate
wellness, educational assistance, corporate discounts and more.
What You'll Do
Maintains current information on clinical practice guidelines,
health tech assessments, research studies, policies and
recommendations for expert medical testimony.
Maintains a policy library.
Assists client/customer with issues relating to policy
implementation, processes and appeals and appeals decisions.
Ongoing planning, development, and maintenance of internal
monitoring program for review activities performed by clinical
Develops, coordinates and implements testing and quality assurance
measures and activities.
Assesses potential problems and recommends corrective actions to
resolve or mitigate associated risks.
Monitors the implementation of testing and quality assurance
policies, processes and procedures to ensure uniform application
across the board.
Prepares and submits reports and/or deliverables timely as
Knowledge of Interqual Criteria strongly preferred.
Knowledge of current NCQA/URAC standards strongly preferred.
Must be proficient in Microsoft Office and internet/web
Medical record abstracting skills required.
Knowledge of the organization of medical records, medical
terminology, and disease process required.
Strong clinical assessment and critical thinking skills
Excellent verbal and written communication skills required.
Ability to work in a team environment.
Flexibility and strong organizational skills needed.
Assures accuracy and timeliness of all applicable review type cases
within contract requirements.
Analyzes productivity of nurse reviewers and abstractors
Performs all applicable review types as workload indicates.
Functions as providers' liaison and contact/resource person for
provider customer service issues and problem resolution.
Maintains current knowledge base related to review processes and
clinical practices related to the review processes; functions as
the initial resource to nurse reviewers/abstractors regarding all
review process questions and/or concerns.
Responsible for the quality monitoring activities including
identifying areas of improvement and plan implementation of
Identify Clinical Reviewers' orientation and continuous learning
needs and in collaboration with the Manager, Operations, develops
and implements plans to address those identified learning
Assesses, evaluates and addresses daily work load and queues;
adjusts work schedules daily to meet the workload demands of the
For Remote work will require access to phone, internet and secure
workspace for the working environment
What You'll Need
Unrestricted RN, LPN License with Minimum two years of clinical
experience in an acute or med-surgical environment required.
Minimum of one year UR and/or Prior Authorization or related
We know your time is valuable and we thank you in advance for
applying for this position. Due to the high volume of applicants we
receive, only those who are chosen to advance in our interview
process will be contacted. We sincerely appreciate your interest in
Kepro and invite you to apply to future openings that may be of
interest. Best of luck in your search!
- The Kepro Talent Acquisition Team
Mental And Physical Requirements
The physical demands described here are representative of those
that must be met by an employee to successfully perform the
essential functions of this job. Reasonable accommodations will be
made as required by law in an attempt to enable an individual with
a disability to perform the essential functions of this job. While
performing the duties of this job, the employee is regularly
required to sit for prolonged periods of time; key and/or control
objects; interact extensively with internal and external customers;
occasionally lift and/or move objects weighing up to 10 pounds; and
occasionally travel within the state.
EOE AA M/F/Vet/Disability
Kepro is an Equal Opportunity Employer. All qualified applicants
will receive consideration for employment without regard to race,
color, religion, sex, sexual orientation, gender identity, national
origin, disability, or status as a protected veteran.
Keywords: Kepro, Kansas City , Quality Nurse Specialist - Fully Remote, Healthcare , Kansas City, Kansas
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