Kentucky 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

Required Qualifications

Active, unrestricted RN license in the U.S. and in the candidate's state of primary residence, with a current multistate compact (NLC) license required

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