Case Review Registered Nurse

Job Description

In accordance with Navajo Nation and federal law, TCRHCC has implemented an affirmative action plan pursuant to the Navajo Preference in Employment Act. Candidates who meet the necessary qualifications and are enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe will receive hiring preference. Legal spouses of enrolled members and members of other federally‑recognized tribes receive secondary or tertiary preference as outlined in the plan.

The position facilitates the analysis of medical staff quality and performance data, coordinating information collection, data analysis, and trending of required medical staff quality and peer review activities. It supports the medical staff with practitioner‑specific quality monitoring and reporting, manages quality issues raised by providers, evaluates and investigates quality concerns, and oversees ongoing professional practice evaluations and focused professional practice evaluations.

It also supports the Peer Review Committee and other quality‑related projects.

Bachelor’s degree in Nursing and a Master’s degree in Business Administration or another Master’s degree in healthcare.

A valid, current, full and unrestricted Professional Nursing License in any U.S. state, the Commonwealth of Puerto Rico, or a U.S. territory.

Five (5) years of supervisory experience in discharge planning, case management, or utilization review in an acute‑care health care setting or related healthcare clinical leadership.

• Accessing community resources for patient referrals
• Elimination of potential conflicts of interest, including professional, organizational, and personal bias inherent to review programs
• Providing a systematic and scalable approach that ensures accurate, reliable review criteria and results, reducing risk by identifying trends and potential issues of clinical staff performance, deficiencies, and errors
• Knowledge of DRG and documentation requirements
• Positive working relationships with others
• High ethical standards and no history of complaints
• Reliability and dependability; reports to work as scheduled without excess absences
• Ability to sense varying skill levels and provide instruction accordingly
• Detail oriented, well organized, applies critical thinking, reasoning, deduction, and inference skills
• Knowledge of report writing, graphical analysis, and proficiency with computer spreadsheets and database programs
• Excellent interview performance, demonstrating the applicant can perform essential job functions
• Successful background and reference checks, showing satisfactory performance records
• Successful completion of fingerprint clearance, physical examinations, and mandatory screenings
• Submission of all required employment documents, applications, resumes, references, and mandatory information without false or incomplete data

The work involves prolonged sitting at a computer, walking to review records, standing while interacting with providers, driving, bending, climbing, and mandatory lifting, pulling, and pushing up to 10 pounds. Mandatory use of prescribed vision and hearing; mandatorily not mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory mandatory…