Sunflower Health Plan
**Applicants for this role have the flexibility to work remotely from their home anywhere in the state of Kansas or the Kansas City metro area.** Position Purpose: Review medical records for potential Quality of Care (QOC) incidents, applying clinical criteria to determine if a lack of care was present. Utilize clinical knowledge to provide summary of findings and severity level to physicians.
Associateās degree in Nursing required; Bachelorās degree in Nursing preferred. 3+ years of experience in nursing or related healthcare experience. License/Certification: RN/LCSW required; CPHQ preferred
Review medical records for quality of care incidents by determining if the specified standards of care were met, and assigning an initial severity level of lack of compliance/care Compile timeline and summary of incident, including the details of the potential QOC for presentation to the medical director for a final review; may also be involved in peer review committee actions or next steps Maintains organizational and program policies and procedures; ensures adherence to prescribed policies and procedures and clinical protocols where appropriate
Basic
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