Job Description

The RN Clinical Case Reviewer provides expertise for clinical quality of care cases from ESRD patients in which the grievant alleges that a dialysis provider did not meet professionally recognized standards of clinical care. They may also provide clinical and technical expertise to dialysis providers in the development and implementation of quality improvement, quality assurance, and medical review if or when a concern is substantiated. Other functional areas of the organization as directed and performs other duties as assigned. This position reports to an ESRD Network Executive Director. The position is based on contract and consultant duties will be performed as needed.

Essential Duties and Responsibilities

1. Perform Clinical Quality of Care case reviews and PCU entry, as applicable.
2. Develops clinical process improvement plans as needed.
3. Educates facilities in the principles of continuous quality improvement.
4. Provides technical assistance to facilities on clinical quality of care.
5. Maintains case specific records.
6. Collaborates with the Medical Review Board (MRB) and Patient Services Manager.
7. Prepares final reports to the Patient Services team, MRB, Centers for Medicare and Medicaid Services (CMS), and Executive Directors as needed.
8. Maintains proficiency with the CMS ESRD Network Statement of Work (SOW).
9. Educates patients and dialysis providers on clinical areas of concern related to grievances or facility concerns Analyzes data and maintains records as directed by the CMS contract.
10. Collaborates with Patient Services Manager (PSM), Marcom POC, and other ESRD team members in the development and publication of patient educational resources by providing guidance, content, and editing.
11. Assists in the planning and implementation of educational meetings as necessary.
12. Participates in State Survey Agency/CMS bimonthly calls to provide updates on assigned QIAs and request agenc yfeedback when needed.

Knowledge, Skills & Abilities

1. Quality improvement knowledge through healthcare application, implementation and evaluation required. 
2. Nephrology/dialysis or ESRD Network experience preferred.
3. Ability and desire to collaborate with team members but comfortable self-managing when needed.
4. Skilled in managing multiple projects and tasks simultaneously, with close attention to detail and accuracy.
5. Experience in coordinating health programming, and/or quality improvement initiatives
6. Demonstrates a high-level of interpersonal and communication skills, written and verbal.
7. Must be proficient in the use of Microsoft Office products: spreadsheet, word processing, email, Internet browser and database software; and contact management systems.

Education, Experience, & Licensing Requirements

Education

1. Bachelors’ degree or equivalent experience required. 
2. Current Registered Nursing license required, in good standing.

Experience

1. Certified Professional in Healthcare Quality (CPHQ) preferred, or 5 years Quality Improvement healthcare experience preferred.
2. Experience managing projects and developing health education also preferred.
3. Preferred: Certified Nephrology Nurse (CNN).

Travel Requirements

1. Employee will work remotely from a home-based office. Approximately 25% travel required.

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