RN Quality Assurance Reviewer

Job Summary

A company is looking for a RN Quality Assurance Reviewer (100% Remote).

Key Responsibilities

• Audit clinical documentation and calls to ensure compliance with NCQA, URAC, and client requirements
• Support clinical operations in pre-delegation, delegation, and accreditation reviews
• Prepare and deliver weekly reporting statistics of audit activities and outcomes

Required Qualifications, Training, and Education

• Bilingual in English and Spanish
• RN or LPN licensure and a Bachelor's degree required (8+ years of clinical quality improvement experience may substitute)
• Three years of healthcare experience in care management or quality management required
• Experience with electronic medical records and data analysis required
• Knowledge of regulatory, CMS, and accreditation agencies (NCQA and/or URAC) preferred