Texas Licensed Clinical Quality Nurse

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

Key Responsibilities

Perform QA checks on complex clinical claim reviews

Review and analyze claim data and medical records using approved guidelines

Document determinations clearly and concisely and report quality findings

Required Qualifications

Active, unrestricted RN license in the U.S. with a current multistate compact (NLC) license

Associate degree required; bachelor's degree preferred

5+ years of clinical experience in an acute setting

3+ years of medical record review / auditing experience preferred

Expert level experience applying MCG and / or InterQual criteria