Job Summary

A health insurance company has an open position for a Remote Quality Assurance Registered Nurse.

Core Responsibilities Include:

• Providing clinical expertise support for company vendors and Medical Directors
• Creating and assigning inter-rater reliability reviews to RN reviewers and Medical Directors
• Completing monthly MD Quality Assurance (QA) reviews to ensure clinical compliance with Medicare regulations

Position Requirements Include:

• Current RN license
• Minimum of 3 years of Utilization Management medical necessity review experience
• Quality Assurance experience
• Strong knowledge of applying CMS guideline, and NCD-LCD to medical necessity reviews
• Previous experience in leading vendor relationships and building clinical review teams
• Excellent interpersonal skills and ability to communicate with patients and colleagues