Clinical QA Nurse Specialist
New
V
VidaVirtual care
Listing location: United States; Workplace type: RemoteFull-TimeJunior
Salary36 - 38 USD per hour
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Job Details
- Experience
- Minimum of 2 years of experience in a primary care, family medicine, internal medicine, or outpatient clinical setting.
- Required Skills
- Google WorkspaceSlackZendesk
Requirements
- Hold an active RN or LPN license in good standing.
- Have at least 2 years of experience in primary care, family medicine, internal medicine, or an outpatient clinical setting.
- Have experience reviewing medical records and clinical documentation.
- Demonstrate strong written and verbal communication, organizational skills, and attention to detail.
- Be able to analyze situations, identify issues, and implement appropriate solutions.
- Be able to work independently in a fully remote environment and manage multiple priorities in a fast-paced setting.
- Demonstrate strong computer and technology proficiency, including the ability to navigate multiple systems accurately and efficiently.
- Be able to use Slack, Google Workspace, Zendesk, Zoom, electronic medical records, and telehealth platforms.
- Provide compassionate, patient-centered support and adapt to evolving workflows, platforms, and processes.
- Preferred: experience in telehealth or virtual care; utilization management, prior authorizations, or clinical review; obesity medicine, chronic disease management, primary care, or population health; quality assurance, compliance, clinical operations, or care coordination; or familiarity with electronic prescribing systems and electronic medical records.
Responsibilities
- Intake, triage, track, and respond to clinical review requests, escalations, and inquiries in accordance with service level agreements.
- Review and analyze patient medical records, extracting relevant clinical information for providers and leadership.
- Investigate clinical escalations from members and internal teams, including Member Support, Account Management, and Clinical Operations.
- Respond to member inquiries in accordance with clinical guidelines and program requirements.
- Collaborate with providers, Clinical Assistants, and cross-functional teams to support continuity of care and resolve member concerns.
- Monitor cases through resolution and ensure timely follow-up and documentation.
- Identify trends, process improvement opportunities, and potential member safety concerns to support quality assurance.
- Assist with provider performance monitoring, quality reviews, and operational audits.
- Maintain accurate and timely documentation and use provider messaging platforms, templates, workflows, and telehealth technologies.
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