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Health Care Service
Quality Of Care And Clinical Review Nurse
Remote · United States · Full time · Mid level
$69.8k–$126k / year
About the role
Conduct reviews and investigations of potential quality of care issues under QOC Manager supervision. Ensure compliance with state and federal regulatory requirements including CMS and NCQA.
What you’ll do
• Review and investigate quality of care issues timely. • Conduct quality improvement activities per regulations. • Evaluate medical records for care appropriateness. • Assess clinical performance of health professionals. • Maintain confidentiality of sensitive quality documents.
What you’ll bring
• Registered Nurse with unrestricted license. • 5 years healthcare process knowledge. • Knowledge of managed care processes. • Strong communication and organizational skills. • Proficient with Microsoft Word, Access, Excel.
Life at Health Care Service
Offers health and wellness benefits, 401(k), pension, paid time off, parental leave, disability and life insurance, tuition reimbursement, and employee assistance programs.
About Health Care Service
Health Care Service Corporation is a purpose-driven company investing in employee development and committed to quality healthcare services.