Florida Licensed Clinical Quality Nurse

Job Summary

A company is looking for a Clinical Quality Nurse Reviewer, Sr. Specialist.

Key Responsibilities

• Conduct quality assurance checks on complex clinical claim reviews and ensure accuracy of determinations
• Analyze claim data and medical records using approved clinical guidelines; document findings clearly
• Provide detailed quality review results for reporting and trend analysis; help identify quality issues and support remediation efforts

Required Qualifications

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