Senior Registered Nurse
Company: Mass General Brigham
Location: Everett
Posted on: October 4, 2024
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Job Description:
**Mass General Brigham Seeks Sr. Clinical Quality Assurance
Nurse Auditor**
Mass General Brigham is seeking a Registered Nurse (RN) with 5-10
years of clinical experience to fill a Sr. Clinical Quality
Assurance Nurse Auditor position in Everett, Massachusetts.
**Job Description:**
The Sr. Clinical Quality Assurance Nurse Auditor will be
responsible for coordinating clinical quality assurance activities,
including developing and reviewing training materials, auditing
clinical team members, and preparing for NCQA audits. The Nurse
Auditor will evaluate individuals' compliance with clinical
processes, National Committee for Quality Assurance (NCQA)
standards, regulatory requirements, and overall clinical program
effectiveness and efficiency.
**Key Responsibilities:**
* Conduct monthly file audits for all file requirements
* Participate in and/or lead clinical Inter-rater Reliability
Testing (IRR)
* Proactively communicate and collaborate within the Clinical and
Quality Departments to identify key areas of focus and develop a
Quality Assurance (QA) plan
* Develop written summaries of specific key areas of training
required for clinical staff based on audit results
* Monitor staff adherence to designated NCQA UM, NCQA Complex Care
Management (CCM), Quality Improvement (QI) and other standards,
contractual and regulatory requirements with ongoing assessment of
performance
* Work with the Clinical Quality Assurance Manager to communicate
recommendations for operational changes based on survey findings to
Quality and Clinical leadership
* Participate in training activities for clinical staff to support
adherence to NCQA and other regulatory and internal documentation
standards/requirements
* Participate in the training of the InterQual products for new UM
staff and MD's and any updates as needed
* Proctors/administers the Inter-rater Reliability Testing to
applicable clinical staff
* Conduct Utilization Management chart reviews to ensure that
Clinical Screening Criteria (InterQual) has been applied
correctly
* Supports business requirements for system and process
improvements
* Works with Medical Record Review staff to assist with the medical
record review process
* Supports the Appeals and Grievance team to assist with auditing
and compliance
* Research pertinent information as requested
* Produce correspondence and maintain a chronological log/file
**Requirements:**
* Registered Nurse with 5-10 years of clinical experience in a
health care setting
* 5-10 years of health care experience with 2 years of health
plan/insurance experience
* Valid unrestricted Massachusetts RN professional license
* Quality Assurance auditing experience a plus
* NCQA experience preferred
* Complex Care Management experience preferred
* Utilization Management (InterQual) experience preferred
**Skills/Abilities/Competencies:**
* Excellent verbal and written communication skills
* Experience using MS Office Suite and SharePoint or other
document-sharing software
* Understanding of project management and business practices
* Results-oriented, self-starter, motivated, quick learner,
resourceful with superior problem-solving skills
* Strong organizational skills and attention to detail
* Excellent planning, coordination, and facilitation skills
* Respect the talent and unique contribution of every individual,
culture and ethnic group and treats all people in a fair and
equitable manner
* Exercises self-awareness; monitors impact on others; is receptive
to and seeks out feedback; uses self-discipline to adjust to
feedback
* Accountable for delivering high quality work
* Demonstrate Mass General Brigham Health Plans core brand
principles of always listening, challenging conventions, and
providing value
* Bring fresh ideas forward by listening to and working with
employees and the people we serve
* Respect the talent and unique contributions of every individual
and treat all people in a fair and equitable manner
* Strong, demonstrated track record of an ability to execute on
time, on budget, and on scope
* Strong aptitude for technology-based solutions
* Ability to inject energy, when and where it's needed
* Current in healthcare trends
* Demonstrated forward, visionary thinking; ability to see "what
is" and envision "what could be"
* Ability to develop, introduce, defend, and gain support for a new
ideas and approaches
* Excellent leadership skills and leadership track record
* Ability to translate and communicate complex topics in a variety
of forums, tailoring communications to effectively fit and
influence the targeted audience, strong executive presence,
presentation, and communication skills
* Strong verbal, active listening, and written communication skills
required
* Ability to view the long-range trends and cycles of the business
and industry and see the "big picture"
* Ability to apply a variety of strategic frameworks to analyze
problems and to guide and develop solutions
* Ability to challenge the status quo and drive innovative thinking
and the capability to successfully implement strategy
* Excellent interpersonal skills, including the ability to
influence others at all levels of an organization
* Strong EQ; exercises self-awareness; monitors impact on others;
is receptive to and seeks out feedback; uses self-discipline to
adjust to feedback
* Unquestionable integrity
Keywords: Mass General Brigham, Lawrence , Senior Registered Nurse, Accounting, Auditing , Everett, Massachusetts
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