Aetna Careers Remote Registered Nurse, Aetna Careers ( Quality Management Nurse )

Aetna Careers Remote Registered Nurse, Aetna Careers ( Quality Management Nurse )

Job Name: Quality Management Nurse

Salary : $20 To $30/Hour

Experience: 3 years

Company Name : Aetna

Qualification : Graduate

Location : Colorado

Aetna Careers Remote Registered Nurse, Aetna Careers ( Quality Management Nurse )

Full Job Description:

This position reports to the Possible Nature of Care (PQOC) nurture agent group chief. This position is answerable for the audit and assessment of safeguarded clinical data and documentation. The PQOC group audits documentation and deciphers information got from clinical records or frameworks to apply suitable clinical models and strategies in accordance with administrative and certification prerequisites for part and additionally supplier issues. Works Possible Nature of Care cases (Clinical and Social Wellbeing), alongside Tolerant Security Occasions across all lines of business (Business, Government medical care, and Medicaid). Autonomously organizes the clinical goal with inward/outer clinician support as required. Aetna Careers Remote Registered Nurse, Aetna Careers.

Audits documentation and assesses Expected Nature of Care issues in view of clinical arrangements and advantage judgments. Thinks about undeniably reported framework data as well as any extra records/information introduced to foster an assurance or proposal. Information gathering requires route through different framework applications. Staff might be expected to contact the suppliers of record, sellers, or inward Aetna divisions to get extra data. Assesses documentation/data to decide consistence with clinical arrangement, administrative and license rules.

Precisely applies decisive reasoning abilities what’s more with group based choice rubric to guarantee case is explored by a professional with clinical mastery for the main thing in need of attention.

This position orders a far reaching information on complex designation courses of action, contracts (part and supplier), clinical rules, benefit plan structure, administrative necessities, organization strategy and different cycles which are expected to help the survey of the clinical documentation/data.

Favorable to effectively and reliably applies administrative and authorization norms to guarantee that exercises are explored and handled inside rules. Consolidates complex data into an unmistakable and exact clinical picture while working freely. Reports review or clinical discoveries to fitting staff or others to guarantee suitable result as well as follow-up for development as demonstrated. The occupant should major areas of strength for show judgment as well as information on interior frameworks.

Required Capabilities:

• – RN with Current Unlimited State Licensure Required
• – RN permit should be either minimal or potentially a RN permit for NY, IL, or Dad
• – 3+ long stretches of clinical experience required
• – 6 months+ of Overseen Care Insight

Favored Capabilities:

• – Experience Working Complaint Cases
• – Social Wellbeing experienced liked
• – Frameworks experience liked: ATV, ASD, GPS, Drug
• Compass, QNXT, Dynamo, HRP, MedHok
• – Use The board or Case The executives experience
• – Four year certification
• – Experience Working with Administrative Offices
• – Decisive reasoning abilities
• – Experience working in a remote/virtual climate

Instruction:

• – Four year certification liked
• – Partner’s Certificate least required

Business Outline:

Carry your heart to CVS Wellbeing All of us at CVS Wellbeing shares a solitary, clear reason: Carrying our heart to each snapshot of your wellbeing. This reason directs our obligation to convey upgraded human-driven medical services for a quickly impacting world. Secured in our image — with heart at its middle — our motivation sends an individual message that how we convey our administrations is similarly essentially as significant as what we convey. Our Heart At Work Behaviors™ support this reason. We need each and every individual who works at CVS Wellbeing to feel enabled by the job they play in changing our way of life and speeding up our capacity to advance and convey answers for make medical care more private, helpful and reasonable. We endeavor to advance and support a culture of variety, consideration and having a place consistently. CVS Wellbeing is a governmental policy regarding minorities in society boss, and is an equivalent open door manager, just like the doctor possessed organizations for which CVS Wellbeing gives the executives administrations. We don’t segregate in enlisting, employing, advancement, or some other work force activity in light of race, identity, variety, public beginning, sex/orientation, sexual direction, orientation personality or articulation, religion, age, handicap, safeguarded veteran status, or some other trademark safeguarded by pertinent government, state, or nearby regulation. We gladly support and energize individuals with military experience (dynamic, veterans, reservists and Public Watchman) as well as military mates to go after CVS Wellbeing position open doors.

Aetna Careers Remote Registered Nurse, Aetna Careers ( Quality Management Nurse )

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Aetna Careers Remote Registered Nurse, Aetna Careers ( Quality Management Nurse )