Job Description
Name: RN Utilization Review (Remote/Hybrid)
Facility: Cedars-Sinai Medical Center
Location: Los Angeles, CA 90048
Contract: 3+ month (Possible for extension)
Payrate: $65/hr on W2
Shift: Days
Timings: 8am to 5pm.
Roles:
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.
Job Tags
Contract work, Remote job, Shift work,
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