Registered Nurse Quality Specialist

Job Summary

To ensure regulatory compliance and quality oversight, the remote Clinical Specialist, Quality Management I will evaluate clinical systems, conduct audits, and develop training programs for Utilization Management, Case Management, and Chronic Disease Management initiatives.

Key responsibilities:

• Ensure compliance with state, federal, and accreditation requirements through audits and documentation reviews
• Develop and deliver training curricula aligned with compliance standards and operational workflows
• Evaluate training effectiveness and maintain training records while identifying improvement opportunities

Required qualifications:

• Active, unrestricted Registered Nurse (RN) license required; additional licensure may be necessary based on program scope
• Bachelor's degree preferred
• 2-4 years of experience in Utilization Management, Case Management, and/or Chronic Disease Management required
• Demonstrated ability to apply adult learning principles and deliver effective training
• Knowledge of applicable regulations and accreditation standards (e.g., HIPAA, NCQA, URAC) is essential