Clinical Quality RN
1 week ago
We are seeking a highly skilled Clinical Quality RN to join our team in San Antonio, TX. This is an exciting opportunity for a dedicated professional to make a meaningful impact in healthcare.
Key Responsibilities:
This role will involve monitoring and reporting compliance issues, as well as overseeing utilization management functions to ensure adherence to regulatory requirements. The ideal candidate will have experience in a managed care setting, hospital settings, or physician practice settings. A strong understanding of CMS, URAC, and NCQA guidelines is essential.
Requirements:
To be successful in this role, you will need:
• A Bachelor of Science in Nursing (BSN) degree from an accredited nursing school
• Current unrestricted Registered Nurse (RN) license in Texas or other participating states
• At least 5 years of progressively responsible healthcare experience, including experience in a managed care setting, hospital settings, and/or physician practice settings
• 3+ years of experience in managed care with at least 2+ years of Utilization Management experience
• Knowledge and experience with CMS, URAC, and NCQA
• Strong analytical and problem-solving skills, with the ability to communicate complex ideas effectively
• Excellent leadership and collaboration skills, with the ability to work effectively in a fast-paced environment
• Proficiency in Microsoft Office applications, including Windows, Word, Excel, and PowerPoint
Benefits:
We offer a competitive salary range of $93,000 - $123,000 per year, based on experience, along with a comprehensive benefits package, including medical, dental, and vision coverage, 401(k) matching, and paid time off. We also offer opportunities for professional growth and development, as well as a collaborative and dynamic work environment.
Location:
This position is located in San Antonio, TX, near Interstate Highway I-10 West, providing easy access to major highways and amenities.
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