Note: The job is a remote job and is open to candidates in USA. TriWest Healthcare Alliance is dedicated to serving America's heroes through healthcare solutions. The Clinical Quality Study Analyst role involves conducting quality studies and improvement projects to ensure compliance with Clinical Quality Management standards for Veterans and DoD beneficiaries.

Responsibilities

• Conducts research and writes clinical quality studies to identify, develop and evaluate processes to improve delivery of care to Veterans and/or DoD beneficiaries
• Acts as facilitator on quality improvement team projects and utilizes appropriate quality improvement methodologies and standardized quality management tools
• Leads and performs quality management audits
• Identifies, develops, and monitors focused reviews and other quality studies
• Identifies Potential Quality Issues (PQIs) by performing a timely review of the medical records. This includes researching, investigating, analyzing, and preparing case summaries with recommendations for further review
• Reviews Potential Quality Issues with Medical Directors when appropriate
• Prepares peer reviewed cases for quality committees and monitors corrective action plans
• Uses data management software to identify physician practice patterns, over- and under-utilization of care and services, complication rates, and high-cost outliers
• Prepares and submits activity and projects reports
• Performs other duties as assigned
• Regular and reliable attendance is required

Skills

• Registered Nurse with current unrestricted license in appropriate state
• 1 year experience in Quality Management
• 1 year experience in data analysis and writing clinical quality studies
• 5 years Medical/Surgical experience
• US citizenship and a favorably adjudicated DOD background investigation if selected to work under TRICARE/DoD Contract
• Bachelor's degree in Nursing or CPHQ
• Experience with team facilitation and project management
• Experience with Medicare, Veteran's Administration, TRICARE, or other government health care programs

Benefits

• Medical, Dental and Vision Coverage
• Paid time off
• 401(k) Retirement Savings Plan (with matching)
• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
• Tuition reimbursement
• Paid volunteer time
• Frequent pay raises
• Overtime opportunities to earn even more
• Recognition and reward programs

Company Overview