Remote Nurse Quality Analyst (RN) for Medicaid & AI QA

Acentra Health; United States; A distancia; USD 74.000 - 92.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Comprehensive health plans

Paid time off

Retirement savings plan

Educational assistance

Wellness programs

Descripción de la vacante

Acentra Health is seeking a Nurse Quality Analyst to join the Integrated Health Solutions team in a fully remote role within the United States. The position focuses on evaluating utilization management reviews for Medicaid programs, including AI-assisted reviews, and driving quality improvements across clinical documentation and criteria adherence.

The analyst will train staff, maintain audit records, generate reports, and collaborate with leadership to identify trends and implement corrective

Formación

• Active, unrestricted RN license.
• State-approved nursing education program (certificate, diploma, associate or bachelor’s preferred).
• 3+ years of clinical nursing or utilization management experience with quality audits.
• Extensive experience with Medicaid programs.
• Experience reviewing prior authorization, concurrent review, retrospective review using established clinical criteria.

Responsabilidades

• Plan, develop, implement, and monitor internal QA/improvement programs for utilization management operations.
• Perform quality audits of Medicaid UM reviews, including AI-assisted reviews.
• Evaluate clinical review accuracy, timeliness, medical necessity rationale, and criteria compliance.
• Validate AI-assisted outputs against clinical documentation and policies.
• Develop standardized audit tools and track inter-rater reliability and other quality measures.
• Document and analyze audit findings, identify trends, and communicate recommendations to leadership.
• Maintain IQC databases, audit records, trend reports, and action plans per contract requirements.
• Prepare recurring/ad hoc quality reports for leadership and stakeholders.
• Collaborate with operations managers, medical directors, and training teams on improvements.
• Identify training needs and deliver education for clinical staff and DHA staff.
• Facilitate calibration sessions to improve review consistency and documentation accuracy.
• Support workload with medical record abstraction, reviews, quality studies, and other activities.
• Stay current with Medicaid practices, regulatory requirements, and AI in clinical workflows.
• Serve as backup to Director of Operations as needed.
• Read and adhere to corporate policies including HIPAA rules.

Conocimientos

RN license

Nursing education

UM/quality experience

Medicaid experience

Quality audits

Educación

RN education program (certificate/diploma/associate/bachelor's preferred)

Descripción del empleo

Acentra Health is seeking a Nurse Quality Analyst to join the Integrated Health Solutions team in a fully remote role within the United States. The position focuses on evaluating utilization management reviews for Medicaid programs, including AI-assisted reviews, and driving quality improvements across clinical documentation and criteria adherence.

The analyst will train staff, maintain audit records, generate reports, and collaborate with leadership to identify trends and implement corrective