Registered Nurse Clinical Specialist - job 1 of 2

Job Summary

A company is looking for a Clinical Specialist, Quality Management & Performance.

Key Responsibilities

• Ensure compliance with state, federal, NCQA, and URAC standards
• Conduct internal and external audits of clinical programs and prepare quality assurance reports
• Train clinical staff on regulatory requirements and collaborate with cross-functional teams to resolve quality issues

Required Qualifications, Training, and Education

• Active unrestricted Registered Nursing License
• Bachelor's Degree preferred
• 2-4 years of experience in Utilization Review (UR), Case Management (CM), or Disease Management (DM)
• Managed care experience preferred
• Basic computer literacy and proficiency in Microsoft Office applications