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The Lead, Quality Assurance Nurse is responsible for case management quality assurance and mentorship to equip operations with tools for consistent delivery of CorVel’s case management services as follows:
Oversee the daily tasks and performance of assigned team members.
Develop, implement and provide ongoing quality assurance calibration of processes both managed and delivered at the operational level.
Develop and implement a case management mentoring process both managed and delivered at the operational level.
Educate and equip operations with performance measurement and reporting tools that can be used to objectively measure and grow operations.
Provide national account and regulatory quality oversight.
As applicable, provide oversight and management of URAC compliance and renewals.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:
Coordinate activities and ensure consistency of the Case Management Quality Assurance and Training Team
Work with executive, general and case management department management to ensure the case management department has implemented and is following CorVel standards inclusive of quality assurance, reporting and management processes
Work closely with future talent acquisitions to ensure the consistent full implementation and training of all case management managers to CorVel standards, case management and report system usage
Identify and participate in training and developmental needs of the case management leadership and including the training /re-training of all offices on standards and procedures, including usages of the CorVel case management and reporting system
Develop, run and interpret management reports to ensure the case management operations are utilizing the tools available to manage compliance of services delivery within company standards
Facilitate peer-to-peer quality reviews to ensure delivery of quality case management
Review results and outcomes with general management and case management leadership and develop action plans where warranted
Make recommendations in collaboration with field operations to ensure actions toward improvement are identified
Develop and oversee case management manager mentor program to facilitate the onboarding of new supervision and management to equip field with the tools for compliance and consistency of CorVel standards and procedures
Implementation, oversight and communication of regulatory requirements within case management services to include, state, federal and URAC
Identify trends and recommend action plans to management for continuous process improvement
Performs other duties as assigned
Ability to travel up to fifty percent of the time
KNOWLEDGE & SKILLS:
Proven leadership and mentorship skills
Excellent oral and written communication skills
PC literate, including Microsoft Office (Word, Excel)
Strong knowledge of the clinical and case management processes
Strong knowledge and experience in quality assurance and training programs
Proficient in identifying case management office improvement opportunities and communicating and implementing solutions
Ability to remain poised in stressful situations and communicate diplomatically via telephone, computer, fax, correspondence, etc
Ability to skillfully manage multiple, complex projects and competing priorities concurrently while working under pressure to meet deadlines and maintaining strong customer service orientation
Effective quantitative and analytical skills
Must have strong organizational skills
Ability to work independently or in a team environment while functioning as an educator rather than an auditor
Knowledge of the entire claims administration, case management and cost containment solution as applicable to third party administrator operations
EDUCATION & EXPERIENCE:
Graduate of accredited school of nursing with a diploma/Associates degree (Bachelor of Science degree or Bachelor of Science in Nursing preferred)
3 or more years of recent clinical experience, preferably in rehabilitation
National certification (CRC, CIRS, CCRN, CVE, CCM, etc.), CCM preferred
Four year degree at an accredited college or university preferred
Certified Trainer and/or Quality Assurance distinction, a plus
Four (4) years of case management experience preferred or equivalent experience
Prior quality assurance and/or training a plus
Current RN licensure
PAY RANGE:
CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.
Pay Range: $65,450 – $108,911
A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management
ABOUT CORVEL:
CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).
A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.
CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.
