Quality Review and Improvement Nurse
3 days ago
CareFirst BlueCross BlueShield is seeking a seasoned Clinical Quality Assurance Specialist to join our team in the Government Programs Appeals Department. As a key member of our quality review team, you will be responsible for evaluating clinical quality and procedures within our department, ensuring compliance with regulatory standards.
The ideal candidate will have significant clinical nursing experience, with a strong background in quality auditing and improvement. A Master's degree in nursing is preferred, and experience with government programs, utilization management, and managed care is highly valued.
Key Responsibilities- Evaluate clinical quality and procedures within the Government Programs Appeals Department
- Develop and implement systematic audit tools to measure compliance
- Collaborate with training teams to develop resources for appeals and grievance education
- Trend results of clinical reviews and present findings to stakeholders
We offer a competitive salary range of $75,888 - $150,722, based on experience. In addition to our comprehensive benefits package, including medical, dental, and vision insurance, and a 401(k) plan with company match, you will have opportunities for professional growth and development.
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Nurse Quality Improvement Specialist
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Nurse Expert in Quality Improvement
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Utilization Review Nurse Specialist
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Quality Improvement Nurse Lead
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Baltimore, Maryland, United States CareFirst BlueCross BlueShield Full timeKey ResponsibilitiesEvaluate clinical quality and procedures within the Clinical Appeals & Grievance Department for Government Programs, ensuring compliance with regulatory standards.Audit clinical appeals and grievance letters/documentation, reporting and analysis to support quality improvement initiatives.Collaborate with other business units, including...
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Baltimore, Maryland, United States LifeBridge Health Full timeJob SummaryThis is a part-time position as a Clinical Outcomes Specialist at LifeBridge Health, scheduled for 24 hours a week. The ideal candidate will be a Master's or Doctoral prepared Registered Nurse with experience in acute care and a passion for improving quality care outcomes.About the RoleThe Clinical Outcomes Specialist will work within the...
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Nursing Quality Assurance Professional
2 weeks ago
Baltimore, Maryland, United States CareFirst BlueCross BlueShield Full timeCareer OpportunitiesJoin CareFirst BlueCross BlueShield as a Quality Review Nurse and take advantage of our comprehensive benefits package, competitive salary range ($75,888 - $150,722), and opportunities for professional growth and development. As a member of our team, you will have the opportunity to work on challenging projects, develop new skills, and...
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