Florida Licensed Clinical Quality Nurse Reviewer

Job Summary

A company is looking for a Clinical Quality Nurse Reviewer, Sr. Specialist who will perform quality assurance audits of clinical staff work.

Key Responsibilities

• Conduct QA checks on complex clinical claim reviews
• Analyze claims and medical records using approved guidelines
• Document review findings clearly and accurately

Required Qualifications

• Active, unrestricted RN licensure from the United States and in the state of primary home residency
• 5+ years clinical experience in an acute setting
• 3+ years medical record review or quality auditing experience
• Expert level experience applying MCG and/or InterQual criteria