Clinical Quality RN - CT Licensed

Job Summary

To support clinical quality initiatives, the full-time Clinical Quality RN - CT Licensed will perform audits and reviews of medical management case work, ensuring compliance with regulatory standards while working remotely from anywhere in the U.S.

Key responsibilities:

• Evaluate medical management case work to verify compliance with medical necessity criteria and regulatory standards
• Collaborate with Case Management leadership to create and revise operational process documents for case evaluation
• Identify quality of care concerns and report inconsistencies in prior authorization and case management processes

Required qualifications:

• Unrestricted current RN licensure in state of residence
• 1+ years of experience conducting medical necessity reviews using established criteria
• 1+ years of experience managing complex cases and care coordination
• Experience with multiple platforms for case documentation and clinical records
• Proficiency in Microsoft Office, including Word, Excel, and PowerPoint