RN Clinical Quality Analyst - Documentation Review
Frisco , Texas
February 03, 2017

Under the general direction of the Senior Nurse Manager, the RN Clinical Quality Analyst is responsible for conducting call monitoring and case file reviews for phone and non-phone transactions at the clinical and business level. The RN Clinical Quality Analyst will identify opportunities to improve the Customer Experience and drive clinical best practice.

  • Reports directly to the Senior Nurse Manager
  • Ensures team is meeting contractual obligations
  • Conducts call monitoring and case file reviews utilizing the phone and non-phone business level quality transaction methodology, and sampling along with clinical considerations
  • Responsible for entering all call monitoring data into the quality tool on a daily basis, in order to determine causes of quality issues and to solve them
  • Reviews, analyzes, and reports on quality discrepancies as reported through the call monitoring Makes recommendations for corrective and preventative actions as variation and performance gaps
  • Provides immediate feedback to the Nurse Manager that requires performance or corrective action per the quality review process, and adherence to all policies and procedures of the program and organization
  • Leads and participates in call calibrations to ensure credibility of the quality monitoring scoring process
  • Participates in trending activities that support the establishment of quality metrics, and continual process improvements across the organization
  • Responsible for utilizing all technology and resources effectively and efficiently
  • Recommends and creates training opportunities to improve clinical best practice
  • Provides management with daily, weekly, and month end quality results
  • Implements and ensures that processes are in place to monitor quality and program compliance; is accountable for program quality and compliance with standard operating procedures
  • Coaches, counsels nurse to help drive clinical best practices
  • Provides call monitoring training /calibration for associates
  • Provides feedback up and down the organization (positive and constructive)
  • Participates in client meetings; prepares agenda and/or takes meeting notes
  • Translates and oversees organizational strategies for assigned goals; analyzes progress of tactical issues
  • Identifies client issues; receives and triages client requests
  • Proactively identifies program issues and proposes ways in which to address their concerns
  • Maintains positive rapport with clients
  • Performs related duties as assigned

  • Active Registered Nurse (RN) license and possess the ability to be licensed as a Registered nurse in multiple states. All nursing licenses must be free of disciplinary actions and/or restrictions.
  • Quality and/or process improvement experience preferred
  • Clinical experience 5 years
  • Call Center/tele-health experience preferred
  • Graduation from an accredited program
  • Excellent oral and written communication skills
  • Excellent analytical and organizational skills; attention to detail
  • Excellent interpersonal skills
  • Ability to work independently
  • Ability to use a computer for data collection
  • Ability to manage multiple tasks along a parallel process
  • Evidence of continuing education a plus
  • Must have proficiency in Microsoft Word, Excel, and knowledge of Microsoft SharePoint a plus

A little about us:
Where knowledge, reach and partnership shape healthcare delivery.

Know someone who would be interested in this job? Share it with your network.