The role of the Clinical Assurance Nurse is to promote quality, cost-effective outcomes for a population by facilitating collaboration and coordination across care partners. The Clinical Assurance Nurse will conduct proactive audits and data analysis to identify areas for continuous quality improvement. The Clinical Assurance Nurse is responsible for the oversight and monitoring activities in a given Market.

ROLE RESPONSIBILITIES

1. Conduct clinical audits and/or site visits to ensure alignment with clinical standards and appropriate evidence-based practices are utilized; reporting and escalating potential risk exposure and researching quality concerns
2. Collects and analyzes data from Care Partners daily, weekly, monthly or as needed to assess outcome and operational metrics; to include facilitating external communication necessary to obtain required reports
3. Responsible for the extracting clinical performance data for the assigned market and collaborating with the clinical teams to conduct root cause analysis and develop continuous quality improvement actions and training plans.
4. Generate monthly operating reports for assigned Market to submit to Clinical Director and serves as an advisor to management and Care Partners to identify process defects and system opportunities.
5. Coordinate special clinical assurance projects related to clinical management; to include, but not limited to operational support, community resource assessments, training, and education
6. Adheres to the Policies and Procedures set forth by NeueHealth and performs all additional duties as assigned

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
• Associate’s degree in Nursing, preferred
• Minimum 3 years of experience in medical management clinical functions, clinical auditing, or clinical training,
• Working knowledge of Case Management and Quality Management practices
• Risk Adjustment knowledge preferred.
• Microsoft Applications: Word, Excel, and Powerpoint Required. Visio, preferred
LICENSURES AND CERTIFICATIONS
• Active and Unrestricted License as a Licensed Vocational Nurse (LVN) or Registered Nurse (RN)
• Certification Managed Care Nursing (CMCN) preferred

PROFESSIONAL COMPETENCIES
• High level of critical thinking and problem-solving skills
• Strong work ethic and overall positive attitude
• Effective communication skills including verbal and written
• Ability to manage time effectively, understand directions, and work independently in a fast-paced environment
• Demonstrated flexibility, organization, and self-motivation
• Highly adaptable to change

WORK ENVIRONMENT
The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Some travel may be required. 

Bright Health is committed to following the federal government guidelines for vaccination requirements, ensuring the safety of our employees, and helping protect the people we serve. Certain positions, including this position, require full vaccination against COVID-19 (including any booster shots if required), where allowable under the law, unless approved for a reasonable accommodation based on a medical condition or religious belief.