Senior Quality of Care Review Nurse

Responsibilities

• Perform quality audits of internal and external member, provider, and delegated vendor interactions
• Guide interrater reliability (IRR) assessments to support evidence-based clinical decision-making
• Investigate provider and facility quality of care concerns and accelerate negative performance trends
• Consult with company partners to ensure programs meet organizational needs and regulatory requirements
• Present quality and performance trend data to organizational partners and quality subcommittees
• Collaborate on corrective action plans to address identified clinical gaps

Requirements

• Licensed Registered Nurse with an active, unrestricted license in your state of residence
• 2+ years of experience as a Registered Nurse
• 2+ years of experience working in a clinical care setting
• Ability to work remotely from Arizona, Florida, Georgia, or Texas

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