Compact State Licensed RN

Job Summary

A company is looking for a Clinical Quality RN - Remote.

Key Responsibilities:

• Conduct routine and ad hoc audits of clinical program documentation for compliance with CMS, NCQA, and health plan requirements
• Analyze audit findings and translate results into actionable quality improvement initiatives
• Serve as a subject matter expert and communicate audit results to leadership and operational teams

Required Qualifications:

• Current, unrestricted Registered Nurse (RN) license in a Compact state
• 2+ years of managed care experience, including at least 1 year of case management experience
• Experience in medical management and/or complex case management
• Working knowledge of NCQA PHM standards
• Proficiency with Microsoft Office tools (Word, Excel, Outlook, PowerPoint)