RN Licensed Quality Analyst

A company is looking for a Sr Analyst, Health Care Quality Management, Medicaid - Work From Home. Key Responsibilities Manage up to four health plans to ensure compliance with clinical policy, regulatory, and accreditation guidelines Coordinate identification of potential claim editing and clinical program enhancements Support management of savings opportunities and vendor implementation Required Qualifications RN or LPN Clinical Role 3-5 years of claims and policy support experience in the health care industry Familiarity with claim editing software to propose system changes Experienced in root cause analytics and identifying solutions Familiarity in performing claim analytics to validate industry standards

Apr 7, 2025 - 22:10

A company is looking for a Sr Analyst, Health Care Quality Management, Medicaid - Work From Home. Key Responsibilities Manage up to four health plans to ensure compliance with clinical policy, regulatory, and accreditation guidelines Coordinate identification of potential claim editing and clinical program enhancements Support management of savings opportunities and vendor implementation Required Qualifications RN or LPN Clinical Role 3-5 years of claims and policy support experience in the health care industry Familiarity with claim editing software to propose system changes Experienced in root cause analytics and identifying solutions Familiarity in performing claim analytics to validate industry standards