Job Summary

A health insurance plan provider needs applicants for an opening for a Remote Medicaid Quality Nurse.

Candidates will be responsible for the following:

• Assesses current practice patterns, assets and challenges utilizing NCQA Standards, HEDIS audits, site reviews and medical records reviews
• In partnership with the PCP, evaluates results of the Medical record reviews, HEDIS audits, practice assessment
• Establishes a project plan with the practice that establishes goals and objectives for improvement

Qualifications Include:

• AS/BS in nursing or LVN/LPN; 5 years of managed care experience; 2 years of clinical experience; 2 years of professional presentations to small and large audiences; or any combination of education and experience, which would provide an equivalent background
• Current, unrestricted clinical license appropriate to field of specialty (LVN/LPN, RN, NP, PA, LCSW, LSW, etc.) as required
• Quality Management/HEDIS/NCQA review experience
• Valid Driver's License