Taking Care of Our Nation’s Veterans.
It’s Who We Are. It’s What We Do.
Do you have a passion for serving those who served?
Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!
Our job is to make sure that America’s heroes get connected to health care in the community.
At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.
Are you our next Clinical Quality – RN?
Ensures compliance with contract requirements for clinical quality management (CQM) to ensure quality care for Veterans. Identifies and evaluates potential quality issues and prepares summaries for further review and analysis. Supports activities of peer review and quality and safety committees. Reviews discharge summaries and consultation reports for compliance with clinical quality and contract requirements.
TriWest Clinical Quality - RN:
- Identifies Potential Quality Issues (PQIs) by performing a timely review of medical documentation. This includes researching, investigating, analyzing, and preparing case summaries with appropriate recommendations for further actions.
- Develops peer review cases and other quality improvement activities for monitoring deviations from accepted standards of care and suggesting corrective action plans.
- Reviews Practice Pattern Analyses to assist with identifying physician practice patterns for confirmed severity cases.
- Collaborates with VA for data collection, reporting, and analysis of quality issues and contract compliance.
- Participates on safety and quality committees and peer review committees.
- Reviews Potential Quality Issues with Chief Medical Officer when appropriate.
- Provides support for the VA Clinical Quality committee meetings through case summary and report preparation.
- Provides supervisory/team lead support for Complex Authorization Specialists.
- Performs other duties as assigned.
- Regular and reliable attendance is required.
Are you qualified?
Education & Experience
- Registered Nurse or Licensed Clinical Social Worker, with current unrestricted license in appropriate state or territory of the United States
- 3 years clinical experience (medical/surgical or behavioral health)
- Bachelor's in Nursing or Certified Professional in Healthcare Quality (CPHQ)
- 1 or more years team lead or supervisory experience
- 1 year experience in Quality Management
- 1 year experience with data analysis and reporting
- Experience with InterQual or similar criteria sets
- General knowledge of Medicare, Veterans Administration, or other government health care programs
More about working at TriWest Healthcare Alliance
We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:
- Medical, dental and vision coverage
- Generous paid time off
- 401(k) Retirement Savings Plan (with matching)
- Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
Equal Opportunity Employer
TriWest Healthcare Alliance is an equal employment opportunity employer. All qualified applicants are considered for employment, without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other characteristic made unlawful by applicable federal, state, or local laws.
Are you ready to make a difference in the lives of our nation’s heroes?
Since our founding in 1996, TriWest Healthcare Alliance has been On a Mission to Serve our nation's Veterans and military community.
For 17 years, we administered the Department of Defense TRICARE program. We have been proud to serve those who wear America's uniform, those who came before them and their family members. Today, we are privileged to support the health care needs of our nation's Veterans, offering access to quality provider networks and excellent customer service through the Veterans Choice Program.
TriWest Healthcare Alliance
Why Work Here?Taking Care of our Nation's Heroes. It's Who We Are. It's What We Do. Since our founding in 1996, TriWest Healthcare Alliance has been On a Mission to Serve our nation's Veterans and military community. For 17 years, we administered the Department of Defense TRICARE program. We have been proud to serve those who wear America's uniform, those who came before them and their family members. Today, we are privileged to support the health care needs of our nation's Veterans, offering access to quality provider networks and excellent customer service through the Veterans Choice Program.
Join Our Mission to Serve Our Nation's Heroes!