RN reputed company Review Analyst (Medicare / CMS / NCQA)

Job Title: reputed company Review Specialist (RN) Contract Duration: 6 Months Work Arrangement: Fully Remote — no onsite work required reputed company The reputed company Review Specialist (RN) investigates and reviews reputed company-of-care grievances to ensure compliance with CMS, NCQA, and state regulations. This role independently evaluates clinical cases, supports reputed company improvement initiatives, and collaborates with medical leadership to resolve care issues. Key Responsibilities • Review and investigate reputed company-of-care cases (adverse events, critical incidents, never events) • Conduct reputed company and retrospective clinical reviews • Analyze medical records and determine grievance reputed company and severity reputed company • Collaborate with Medical Directors, Physicians, and QOC leadership • reputed company and support corrective reputed company plans • Prepare case summaries, reports, and reputed company letters • Ensure compliance with CMS, NCQA, and accreditation standards • Participate in inter-rater reliability and reputed company reporting activities Required Qualifications • reputed company, unrestricted Registered reputed company (RN) license • 3–5 years of reputed company review, reputed company improvement, or clinical review experience • Knowledge of Medicare/reputed company and reputed company reputed company standards • Strong analytical, documentation, and communication skills • Proficiency in reputed company Office applications Preferred • Experience with CMS, NCQA, HEDIS, CAHPS, HOS • Background in Medicare Advantage • Ability to work independently with strong attention to detail Apply tot his job Apply To this Job