Clinical Quality Nurse Reviewer

Company: VirtualVocations
Location: Hartford
Posted on: November 14, 2024

Job Description:

A company is looking for a Clinical Quality Nurse Reviewer, Sr. Specialist (RN Remote in US).

Key Responsibilities

Perform quality assurance checks on complex clinical claims
Analyze claim data and synthesize medical records using approved clinical guidelines
Identify quality trends and develop remediation activities, including educational materials and training sessions

Required Qualifications, Training, and Education

Active, unrestricted RN licensure in the United States and state of primary home residency
Associate degree required; bachelor's degree preferred
5+ years of clinical experience in an acute setting
3+ years of medical record review/auditing experience preferred
Expert level experience applying MCG and/or InterQual criteria

Keywords: VirtualVocations, New Britain , Clinical Quality Nurse Reviewer, Healthcare , Hartford, Connecticut

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