Quality Nurse Coach

Actalent • Des Moines, IA • 8h ago

Job Title: Quality Nurse Coach

Job Description

As a Quality Nurse Coach, you will be responsible for completing quality reviews of work performed by both clinical and nonclinical staff in Health Services. You will evaluate processes, conduct file audits, review phone calls, and analyze clinical documentation to ensure adherence to standards, policies, and procedures. Your role involves performing audits, conducting research, and analyzing performance metrics. You will provide both group and individual coaching to team members on process, procedure, and guidelines within Health Services. Additionally, you will assist in the development and implementation of new quality review standards and process improvement initiatives.

Responsibilities

Support adherence to processes within Utilization Management and Case Management.

Review and validate denial letters to ensure accuracy and compliance with company policies and standards.

Perform quality checks on all components of denial letters, including medical necessity, coverage criteria, and appropriate use of clinical guidelines.

Conduct quality assurance reviews of call interactions within Utilization Management and Case Management.

Use AWS systems to listen to recorded calls, ensuring compliance with HIPAA requirements and company standards.

Identify areas for process improvement and collaborate with relevant departments to implement changes.

Essential Skills

Completion of an accredited registered nursing program.

Active and Unrestricted Registered Nurse (RN) license in Iowa or South Dakota.

4+ years of clinical or equivalent industry experience, including exposure to complex operational processes or health services-related quality reviews.

Strong communication skills with the ability to articulate and request complex, technical information verbally and in writing.

Ability to establish and maintain positive relations with colleagues, stakeholders, and customers.

Analytical skills with the ability to evaluate data/trends, solve practical problems, and conduct audits and research.

Experience with computer software applications such as Microsoft Office Suite, electronic charting, and documentation systems.

Additional Skills & Qualifications

Interrater Reliability Certification (IRR)

Work Environment

This role is 100% fully remote and operates Monday to Friday, from 8 am to 5 pm. You will be working alongside two other quality coaches in the team led by the Team Leader of Clinical Health Services, Clinical Quality, and Training.

Pay and Benefits

The pay range for this position is $35.00 - $40.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on May 22, 2025.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.

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