Clinical Quality Management Analyst - Registered Nurse - Remote

Overview

The Clinical Quality Management Analyst works to improve compliance, medical record documentation, and quality of care for members while ensuring adherence to coding standards.

In Short

• Develop and manage process improvement initiatives.
• Conduct audits and reviews of medical records.
• Educate providers on coding and compliance standards.
• Analyze data to enhance care and documentation.
• Coordinate various quality improvement activities.
• Monitor regulatory changes and adjust compliance plans.
• Conduct continuing education for providers.
• Maintain quality standards for healthcare services.
• Collaborate with different departments for quality improvement.
• Assist in credentialing and re-credentialing processes.

Requirements

• Current RN or LPN license or Bachelor's degree in healthcare.
• 3 years of experience in nursing or healthcare-related field.
• Knowledge of HEDIS and quality abstraction.
• Experience with medical coding and compliance.
• Strong communication skills.
• Proficiency in Microsoft Office.
• Analytical and problem-solving skills.
• Ability to conduct training and education sessions.
• Understanding of Total Quality Management concepts.
• Ability to work independently and in a team.

Benefits

• Competitive salary range.
• Comprehensive health benefits.
• Opportunities for professional development.
• Flexible work environment.
• Supportive team culture.
• Access to various health-related resources.
• Potential for career advancement.
• Work-life balance initiatives.
• Employee assistance programs.
• Inclusive workplace policies.