Advance Health

Clinical Quality Nurse

Job Location US-VA-Chantilly
Posted Date 1 week ago(3/12/2018 2:33 PM)
Job ID
Regular Full-Time



Advance Health provides industry leading Medicare and Medicaid Prospective Health solutions. Our combination of proprietary mobile workflow technology and highly experienced, dedicated care providers yield outstanding program results and better outcomes for our client's health plan members. We offer truly customized prospective member engagement solutions tailored for each of our client’s unique needs. Founded in 2010 by a team of seasoned health plan professionals, Advance Health was created from the start to leverage best-in-class technology and automation for greater efficiency, data security and automation. It was our belief that we could bring better health care to managed care members by engaging them where and when they were most comfortable, using the best available member specific information and workflow technology. Our network of fully employed, client dedicated, locally based Nurse Practitioners are bringing better care to Medicare and Medicaid members nationwide. Our Providers deeply engage with members, thoroughly reviewing current and past health status, reviewing all medications, and preventative care recommendations.


Job Description


This position is responsible for ongoing clinical quality review and analysis of health care information captured in the Health Risk Assessment (HRA) to (i) ensure the HRA is complete and congruent before export to the Client and (ii) to assist Regional Managers in their clinical oversight of new providers during the onboarding process and for consideration in providers’ annual evaluations. The position requires an ability to manage multiple priorities, ability to coach and motivate to optimize individual and team performance/production, knowledge of medical terminology and medical coding, proficiency with analytical tools (Microsoft Outlook, Word, Excel, etc.), knowledge of AH Quality Assurance Policies, strong communication skills and a strong commitment to and affinity for delivering the highest level of customer service.  





Essential Job Functions/Responsibilities


 Serve as a team resource on clinical issues/questions.
 Assist in developing/implementing workflow for new initiatives, clinical programs and
audit processes (e.g., FOBT processing, MPOC calls, etc.)
 Process/track urgent care reports and clinical quality complaints as assigned.
 Function as a staff liaison with management for addressing concerns,
company/department policy, clinical operations updates, etc.
 Assess and ensure staff has access to training in relevant areas including, but not limited
to, ICD‐10 coding, documentation standards, MMS application enhancements, customer
service/communication, etc.
 Perform HRA clinical quality audits as assigned.
 Compile and track provider audit scores based on clinical information reviewed.
 Conduct timely clinical quality reviews of health risk assessments that fail the initial QA
administrative review.
 Follow‐up and communicate with providers and Regional Managers to promote
effective working relationships and timely maintenance of data integrity efforts.
 Ensure clear, concise, evidence‐based rationale supports all recommendations.


Nonessential Job Functions

  • Other duties as requested.



Skill/Abilities Required


 LPN required
 QA/Audit experience
 Leadership/coaching experience
 Knowledge of medical terminology and ICD‐10 medical coding
 Ability to handle confidential information including PHI and interact professionally with
internal and external clients
 Excellent organizational skills
 Exceptional verbal and written skills
 Proficient with computer and Microsoft applications
 Health plan knowledge a plus
 Bilingual a plus


*Advance Health is an Equal Opportunity Employer*


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