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

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