Senior Nurse - Quality and Accreditation

Key Responsibilities:

• Perform internal and external quality audits of clinical review activities, including interrater reliability and adverse determination notices.
• Provide quality scoring and trend analysis to management with root cause analysis and recommended corrective actions.
• Maintain working knowledge of utilization management workflows, systems, and policies for each program audited.

Qualifications:

• Graduate of an accredited school of nursing with an active, unrestricted RN license in a U.S. state or territory.
• Minimum of 3 years of utilization management experience at a health plan, UM vendor, or delegated UM organization.
• At least 1 year of quality audit, quality assurance, or compliance audit experience.

Compensation & Benefits:

• Base salary range of $80,000 - $90,000 annually, with potential for performance-based bonuses.
• Comprehensive benefits package including medical, dental, vision insurance, PTO, holidays, sick leave, 401(k) match, life insurance, and employee assistance program.
• Equal opportunity employer committed to diversity and inclusion.