LPN / LVN - General

Quality Of Care Investigative NurseThis position conducts quality-of-care investigations as part of a quality management unit. The nurse will investigate complex cases. The role involves analyzing information from multiple sources. Identifying inconsistencies or patterns is essential. The nurse will write detailed, defensible reports. The investigations focus on member-centric and systemic quality-of-care concerns. Timely and thorough investigations are expected. Member health and well-being should be ensured through these investigations. The nurse will implement corrective action plans as needed. Maintaining comprehensive documentation to support case work is required. Requesting appropriate documentation for quality-of-care investigations is part of the role. Comprehensive case records must be maintained to support allegation review. The nurse will issue remediation or corrective action plans as a result of investigations. All relevant investigative information must be uploaded within the designated portal. It is important to elevate cases or trend concerns to the supervisor appropriately. Skills in critical thinking and technological use are necessary. Proficiency in databases, office products, email, and electronic referral sources is expected. The ability to produce professional technical reports and letters is essential. Research and analysis skills are crucial for this role. Strong oral and written communication skills are needed. Personal planning, organization, and time management abilities are important. Experience in medical chart review and nursing processes is required. Decision-making skills are critical for developing effective corrective action plans. Candidates should be able to analyze problems critically. Educational qualifications include an active license to practice as an LPN or RN. Preferred qualifications include a Bachelor's Degree or higher. Experience in preparing formal investigative reports is preferred. Background in healthcare quality assurance, risk management, or regulatory compliance is advantageous. Experience in analyzing complex cases is highly valued.