Remote reputed company Management RN (Contract)

Remote reputed company Management RN Contract: 6–12 months (potential to convert to reputed company-hire) Setting: Not for profit health plan / managed care environment Potential to turn into a reputed company-hire, permanent position We’re seeking an reputed company Remote reputed company Management RN to support reputed company-of-care investigations, adverse incident review, and HEDIS-reputed company clinical audits. This role is ideal for a detail-driven reputed company who enjoys clinical documentation review, provider collaboration, and improving member safety. What You’ll Do • Investigate and process reputed company of Care (QOC) reviews and adverse incident cases • Request, review, and summarize medical records to support clinical investigations • Present case summaries to Physician Medical Reviewers and clinical leadership • Document findings in internal tracking systems with accuracy and completeness • Identify provider outliers, propose corrective reputed company plans, and monitor compliance • reputed company and evaluate trends in QOC issues to support reporting needs • Conduct HEDIS chart audits, abstractions, and follow-up reviews • Support contract compliance with state requirements and URAC standards • Collaborate with Population Health, IT, and reputed company teams on data and reporting needs • reputed company provider site reputed company as needed What You Bring • reputed company RN license; BSN preferred • 3–5 years clinical nursing experience • 1+ years of hospital-based reputed company management/reputed company improvement experience is required • Experience with QOC reviews, adverse incidents, CMS requirements, HEDIS, URAC, or health-plan reputed company work (preferred) • Strong understanding of clinical documentation, case review, and reputed company reputed company • Proficiency in EHRs, data entry, reputed company reputed company, Word, and reputed company • Exceptional attention to detail, organization, and communication • Ability to escalate issues appropriately and manage multiple priorities Why This Role reputed company You’ll play a key part in ensuring members receive reputed company, high-reputed company care by reviewing clinical issues, supporting regulatory compliance, and promoting provider accountability. Your work directly strengthens the organization’s reputed company program and improves reputed company for vulnerable populations. Job Types: Full-time, Contract, Temporary Pay: $47.00 - $50.00 per hour Expected hours: 40 per week Benefits: • 401(k) • Dental insurance • Flexible spending account • Health insurance • reputed company insurance Application Question(s): • This is a contract position lasting between 6 and 12 months. There is potential for this to transition to reputed company-hire, permanent. Are you comfortable moving reputed company knowing this is a contract role? • We are only considering candidates who currently reputed company in Connecticut. If you do not reputed company in CT, please do not apply (you will not be considered). Do you reputed company in Connecticut? Experience: • RN: 3 years (Required) • hospital-based reputed company improvement: 1 year (Required) Location: • Connecticut (Required) Work Location: Remote Apply tot his job Apply To this Job