Remote Clinical Quality Review Nurse III (RN/Coder)

Medica; United States; A distancia; USD 70.000 - 120.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Remote work

Descripción de la vacante

Medica is seeking a Clinical Quality Review Nurse III to conduct medical record reviews and audits across its network in a remote capacity. The role requires an active RN license and a certified coding credential, along with experience in data collection and quality measurement.

You will ensure documentation accuracy, alignment with regulatory standards (HEDIS, CMS, NCQA), and support education for providers.

Formación

• Associate’s or Bachelor's degree in Nursing.
• RN License required.
• Current Coding Certification (CCA, CPC, CPC-P, CPC-H, CCS, CCS-P, RHIT, RHIA) or ability to obtain CPC or CRC within 1 year.

Responsabilidades

• Conduct medical record reviews & clinical quality audits.
• Support quality programs & data collection.
• Complete audits related to CMS Cost, HEDIS, RADV, NCQA site visits & other regulatory requirements.
• Provide education & support to providers & internal partners.
• Contribute to continuous improvement of quality processes.

Conocimientos

Nursing

Clinical quality

Data analysis

Auditing

Quality improvement

Medical record review

Educación

Associate’s degree in Nursing

Bachelor’s degree in Nursing

Herramientas

Adobe Acrobat

Windows

MS Office

Descripción del empleo

Medica is seeking a Clinical Quality Review Nurse III to conduct medical record reviews and audits across its network in a remote capacity. The role requires an active RN license and a certified coding credential, along with experience in data collection and quality measurement.

You will ensure documentation accuracy, alignment with regulatory standards (HEDIS, CMS, NCQA), and support education for providers.