Job Summary

A health insurance company is in need of a Remote Quality of Care Nurse Reviewer.

Core Responsibilities Include:

• Leading quality issues investigations from start to resolution including review of clinical records
• Working with the Medical Director/s to review and resolve confirmed quality of care issues
• Working with providers, members, and internal service team to obtain necessary information and communicate findings

Required Skills:

• Associates degree in Nursing
• Active, unrestricted California Registered Nurse license and can obtain additional state licenses
• 3 + years of experience working as a Registered Nurse in the healthcare setting (preferably managed care or insurance)
• Experience evaluating clinical information and auditing medical records