Nurse Quality Reviewer 252102

Job Title: Quality Reviewer Registered NurseJob ID: 252102Location: New York, NY (Midtown)Onsite: Tuesday–Thursday (required)Remote: Monday & FridaySchedule: Monday–Friday, 9:00 AM – 5:00 PM (35 hours/week)Pay Rate: $43.96 – $63.19/hourOverviewThe Quality Reviewer is responsible for conducting post-service clinical quality reviews to ensure care is delivered in alignment with established standards, regulatory requirements, and health plan guidelines. This role focuses on identifying, investigating, and resolving potential quality of care issues while supporting overall clinical service improvement.Key ResponsibilitiesConduct post-service clinical reviews across all care settingsReview, abstract, and analyze medical records and clinical documentationIdentify quality of care issues, gaps in care, and deviations from standardsTrack, investigate, and resolve clinical quality concernsRecommend corrective actions or sanctions when appropriateCollaborate with internal teams and external vendorsManage assigned caseload while meeting performance and quality metricsApply knowledge of Medicare, Medicaid, and/or TRICARE guidelinesDocument findings and communicate results clearly and accuratelyRequired QualificationsActive RN license in NY or NJMinimum 5 years of clinical nursing experienceMinimum 5 years of healthcare quality management experienceStrong experience with clinical abstraction and documentation review (required)Experience in quality assurance/improvement within managed care or healthcare systemsPreferred QualificationsExperience working within a health plan environment