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Position Description: * VA Program Educator/ Quality Assurance Review Nurse*

Reporting to the Project Manager (PM) , the VA Program Educator/ QA Review Nurse/ provides ongoing education to new and existing review panel members to facilitate their successful participation in the Veterans Health Administration (VHA) Clinical Peer Review program. She/he collaborates with Senior Leadership  and PRITM's Education and Outreach Division to develop and maintain, current, standardized orientation  materials, including  case examples that reflect and respect the Client's needs. Provides support to the Medical Directors in answering peer reviewers questions about navigating VA/government systems or how to locate case-specific documents. The QA Review Nurse/Educator will also perform QA review of peer reviewed case reports to ensure compliance with contract metrics.

Responsibilities:

• Understand and represent PRI's mission, vision, and values to all internal and external customers
• Interact with government and private sector clients, partners, peer reviewers and PRITM staff in a professional and accountable manner, and as a representative of PRITM management
• Engage clients in appropriate communication that manages client expectations and builds a collaborative relationship with the client
• Proactively manages and coordinates activities to ensure timeliness of deliverables to exceed contractual obligations
• Maintains an up to date orientation  schedule and calendar of appointments with reviewers which is  shared with the PC/PM
• Interact with project team members to successfully fulfill contract obligations with the highest quality and in a timely manner meeting PRITM 's ISO requirements
• Instills integrity throughout the organization via active participation in ISO requirements including but not limited to timely submission of Corrective Action Plans for all matters in which either PRITM standards and/or corporate contract standards have not been met. Communicating outcomes to team members to ensure a positive, open, environment which mitigates risk and achieves a culture of Continuous Quality Improvement
• Assists in development and maintenance of standardized orientation materials and case examples.
• Collaborates with Senior Leadership and Education & Outreach Division to ensure orientation materials conform to theories and approaches for adult learning.
• Provides orientation and education to new and existing peer reviewers regarding such things as the process to complete case assignments, navigating the VA EHR and government systems, and submission of completed cases; refers clinical questions to Medical Director as needed.
• Identifies opportunities for continuous quality improvement in education and orientation through feedback from peer reviewers.
• May screen cases upon intake for referral to peer reviewers if needed
• As needed, performs QA review of peer reviewed cases in accordance with Veterans Health Administration requirements
• Works independently to complete assigned trainings; seeks guidance from PM as needed to establish priorities
• Flexible with assignments to meet contract performance metrics
• Participate in interdisciplinary collaboration with PRI staff, recognized teaming partners, and/or subcontractors
• Meets productivity and quality check measures
• When completing QA reviews utilizes the Veterans Health Administration (VHA) electronic medical record system to verify specific details included in the peer review report, such dates of service, laboratory values, vital signs, etc.  
• Perform medical record review in accordance with all State, Federal and/or commercially mandated regulations
• Maintain compliance with all regulation changes as they impact VA medical and utilization review practices
• As directed, analyze patient records and participate in interdisciplinary collaboration with PRI s aff and all recognized teaming partners and/or subcontractors
• Utilize VA electronic health information imaging
• Utilize Internet and Intranet resources for applicable research, e.g., evidence-based standards of care guidelines, quality measures, etc.
• Understand and represent PRI's mission, vision, and values to all internal and external customers
• Perform other duties as requested

Requirements:

• Bachelor's Degree in Nursing (BSN), MSN preferred
• Experience providing orientation and education to all levels of health professionals - including experience with assisting others through complicated systems, etc.
• Two or more years' experience in medical/utilization review and quality improvement/quality management
• Extensive experience performing medical review, utilization/quality assurance, and application of medical evidence based care and nursing standards of care
• Must be a Registered Nurse (RN) with an active license in state of residence
• Broad knowledge base of health care delivery and standards of care across health care disciplines
• Comprehensive knowledge of medical necessity standards, levels of care, inpatient and outpatient status
• Extensive knowledge of state and federal healthcare regulations and policies,
• Excellent writing and communication skills
• Knowledgeable of quality measures and National Quality Strategy
• Knowledgeable of ICD-9-CM/ICD-10-CM, CPT-4 and HCPCS coding desirable
• Knowledge of Microsoft office suite such as Outlook, Access, Excel and Word
• Certification in quality improvement/quality management, and/or utilization management/review preferred
• Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program
• Must have no conflict of interest (COI) as defined in 1154(b)(1) of the Social Security Act (SSA)
• Ability to obtain and maintain U.S. Government Security Clearance

Preference will be given to individuals who reside in, or are willing to relocate to, a recognized HUBZone area.  (Go to http://map.sba.gov/hubzone/maps/ for more information).

FLSA status:  Exempt

Contract Compensation Plan

PRI is an equal employment opportunity employer.  All qualified applicants including Disability/Vets or other qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.

Qualified candidates may apply by clicking, "Apply Now". Next, submit your resume. You may complete a cover letter on the following screen. *You must contact the employer via one of the methods listed on the screen after clicking "Apply for this job". * Please be sure to identify PA CareerLink as your referral source.