Senior Registered Nurse

Company: Mass General Brigham
Location: Everett
Posted on: October 4, 2024

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, Malden , Senior Registered Nurse, Accounting, Auditing , Everett, Massachusetts