Remote Nurse Quality Analyst (RN) - Medicaid Quality & AI

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

Ventajas ofrecidas por este puesto de trabajo

Health plans

PTO

Retirement savings

Educational assistance

Discounts

And more

Descripción de la vacante

Acentra Health, LLC is seeking a Nurse Quality Analyst to join our remote team. The role supports the Integrated Health Solutions division by evaluating quality, accuracy, and timeliness of utilization management reviews across Medicaid programs, including AI-assisted reviews.

You will develop audit tools, analyze findings, train staff, and collaborate with medical directors and operations to drive continuous improvement while adhering to HIPAA and contract requirements.

Formación

• Active, unrestricted RN license
• 3+ years in clinical nursing, UM, quality, or related healthcare with quality audits
• Extensive experience with Medicaid programs and UM reviews
• Read, understand, and adhere to HIPAA and Privacy and Security Rules

Responsabilidades

• Plan, develop, monitor quality assurance programs for utilization management
• Perform audits of Medicaid UM reviews including AI-supported reviews
• Evaluate clinical review accuracy and compliance with criteria and contractual requirements
• Validate AI-assisted outputs against clinical documentation and policies
• Develop audit tools and methodologies for staff performance and quality measures
• Document findings, identify trends, and communicate quality concerns to leadership
• Maintain IQC databases and audit records to meet contractual requirements
• Prepare recurring and ad hoc quality reports for leadership and stakeholders
• Collaborate with operations, medical directors, and training teams on improvement actions
• Identify training needs and deliver education for clinical staff and DHA personnel
• Facilitate calibration sessions to improve review consistency
• Support workload including medical record abstraction and quality studies
• Stay current with Medicaid UM practices and responsible AI usage
• Serve as backup to the Director of Operations
• Read and adhere to corporate policies including HIPAA

Conocimientos

RN license

Quality audits

Medicaid knowledge

UM reviews

HIPAA policies

Educación

Nursing degree or equivalent

Herramientas

AI-assisted clinical review tools

Quality reporting tools

Descripción del empleo

Acentra Health, LLC is seeking a Nurse Quality Analyst to join our remote team. The role supports the Integrated Health Solutions division by evaluating quality, accuracy, and timeliness of utilization management reviews across Medicaid programs, including AI-assisted reviews.

You will develop audit tools, analyze findings, train staff, and collaborate with medical directors and operations to drive continuous improvement while adhering to HIPAA and contract requirements.