Sr. Quality of Care Review Nurse
Core
Analyze clinical data, review patient records, and conduct root cause analyses to improve provider standard of care and patient safety.
Role type
Senior Quality of Care Review Nurse (Clinical Data Analyst)
Builds
Evidence-based strategies for clinical outcomes and regulatory compliance
Domain
Health Insurance / Clinical Quality Assurance
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Medical record review, root cause analysis, regulatory compliance, data analysis, stakeholder consultation, corrective action planning
Preferred skills
Health plan utilization management, case management, NCQA accreditation standards, HEDIS measures, performance data analysis
Technologies
Google Sheets, Google Docs, Google Slides, Google Meets
Responsibilities
Review member complaints and escalate issues; Investigate provider/facility quality concerns; Conduct root cause analyses for adverse events; Perform annual medical record reviews; Consult with stakeholders on quality needs; Present quality trend data to organizational leaders
Seniority
Senior, hands-on IC
