Texas Licensed Clinical Quality NurseVirtualVocations • San Buenaventura, California, United States
Texas Licensed Clinical Quality Nurse
VirtualVocations • San Buenaventura, California, United States
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A company is looking for a Clinical Quality Nurse Reviewer, Sr. Specialist.
Key Responsibilities
Perform QA checks on complex clinical claim reviews
Review and analyze claim data and medical records using approved guidelines
Document determinations clearly and concisely and report quality findings
Required Qualifications
Active, unrestricted RN license in the U.S. with a current multistate compact (NLC) license
Associate degree required; bachelor's degree preferred
5+ years of clinical experience in an acute setting
3+ years of medical record review / auditing experience preferred
Expert level experience applying MCG and / or InterQual criteria
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Clinical Quality Nurse • San Buenaventura, California, United States
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