LPN - Quality of care Investigative Nurse

Schedule The first day requires in-person attendance to obtain equipment and complete necessary security training for system access. Subsequent onboarding and training will be conducted remotely. The work schedule is 8am-5pm, Monday through Friday, totaling 40 hours per week. This position reports to the Quality Management Unit and conducts quality-of-care investigations in accordance with contractual obligations. Participates in investigations of member-centric and systemic quality-of-care concerns to ensure member health and well-being. Conducts timely, thorough investigations of quality-of-care issues and implements vendor-specific corrective action plans using a standardized process. Makes appropriate referrals to oversight and regulatory agencies. Participates in care concerns and member issue investigations as assigned. Maintains all necessary documentation to support case work. Requests appropriate documentation for quality-of-care investigations and ensures comprehensive case records are maintained to support allegation review and substantiation levels. Issues remediation or a corrective action plan to the vendor as a result of investigations and ensures all applicable information and documents are uploaded within the designated portal. Appropriately elevates cases and/or trend concerns to the supervisor. Skills Critical thinking Technological skills, including the use of databases, Microsoft Office products, email, and electronic referral and verification sources Producing professional technical reports and letters Research and analysis Oral and written communication skills Personal planning, organization, and time management Medical chart review Nursing process, including assessment, monitoring, and evaluation Decision-making skills Critically analyze problems and develop effective plans for corrective action Required Education Active license to practice as an LPN #J-18808-Ljbffr Talent Software Services, Inc.