Florida Licensed Clinical Quality Nurse

A company is looking for a Clinical Quality Nurse Reviewer, Sr. Specialist.

Key Responsibilities

Conduct quality assurance checks on complex clinical claim reviews and ensure accuracy of determinations

Analyze claim data and medical records using approved clinical guidelines; document findings clearly

Provide detailed quality review results for reporting and trend analysis; help identify quality issues and support remediation efforts

Required Qualifications

Active, unrestricted RN licensure from the United States and in the state of primary home residency

Associate degree required; bachelor's degree preferred

5+ years clinical experience in an acute setting

3+ years medical record review / auditing experience preferred

Expert level experience applying MCG and / or InterQual criteria