Registered Nurse (RN) Quality Assurance – Clover Health

11% 1-Year Employee Growth Rate | 63% 2-Year Employee Growth Rate | LinkedIn | $1.3B Venture Funding

What Is Employee Growth Rate & Why Is It Important?

Clover is reinventing health insurance by working to keep people healthier.

We value diversity — in backgrounds and in experiences. Healthcare is a universal concern, and we need people from all backgrounds and swaths of life to help build the future of healthcare. Clover's appeals team is empathetic, caring, and supportive. We are deliberate and self-reflective about the kind of appeals team and culture that we are building, seeking nurses that are not only strong in their own aptitudes but care deeply about supporting each other's growth.

As a Registered Nurse (RN) Quality Assurance, you will:

• Provide clinical expertise support for Clover vendors and Medical Directors.
• Create and assign inter-rater reliability reviews to RN reviewers and Medical Directors.
• Complete monthly MD Quality Assurance (QA) reviews to ensure clinical compliance with Medicare regulations.
• Service line clinical reviews.
• Clinical Medical Record Review Subject Matter Expert (SME).
• Identifying clinical opportunities for improvement and communicating to upper management.
• Tracking clinical performance and evaluation of vendors medical reviewers.
• Clinical support for new medical review process implementations.
• Monitor and track CMS Medicare clinical updates that impact Clover clinical processes, partner with management to implement clinical changes.
• Displays Flexibility to adjust work based on new challenges or feedback.
• Clinical collaboration with cross-functional departments.

You will love this job if:

• You have great attention to detail and organizational skills.
• You have a passion for learning.
• You have the ability to work with others to reach a collective goal.

You should get in touch if:

• You are a current RN license; required.
• You have a minimum of 3 years of Utilization Management medical necessity review experience; required.
• You have RN clinical experience in a hospital setting; preferred.
• You have Quality Assurance experience; required.
• You have strong knowledge of applying CMS guideline, and NCD-LCD to medical necessity reviews; required.
• You have previous experience in leading vendor relationships and building clinical review teams.
• You have excellent interpersonal skills and ability to communicate with patients and colleagues.
• You have experience working remotely; preferred.

 

#LI-Remote #LI-GW1

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.

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About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.

We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.

From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone's responsibility.

Tagged as: >50% 2 Yr Employee Growth, 501+ Employees, Hide US-Only Jobs, Venture Funded