Job Summary

A major healthcare company is filling a position for a Telecommute Clinical Quality Registered Nurse in the Philadelphia Area.

Core Responsibilities Include:

• Collaborating with appropriate department to document, investigate and resolve formal or informal member complaints and appeals
• Reviewing and analyzing reports, records, and medical documents/charts
• Coordinating quality management and HEDIS related programs and activities as required

Qualifications Include:

• Travel Yes, 25 % of the Time
• Clinical RN with current, unrestricted license in PA
• 5 years clinical experience
• 1 year of experience working with Grievance and Appeals
• 1 year working in Quality Management in managed care or in the insurance industry
• Experience with Medicaid and/or Medicare