Texas Licensed Clinical Quality RN

Job Summary

A company is looking for an RN Clinical Quality/Primary Source Verification Compact Licensure.

Key Responsibilities

• Complete Supplemental Data Source (SDS), Primary Source Verification (PSV), and Over-read tasks to achieve high productivity and improve STAR ratings
• Serve as a subject matter expert on HEDIS Measures and related tools, and be the primary contact for STAR activities in assigned markets
• Assist in developing training materials and identify barriers to achieving targeted outcomes within provider groups

Required Qualifications

• Bachelor of Science in Nursing, Healthcare Administration, or related field required (or equivalent work experience)
• Registered Nurse with a current license in Texas or other participating states
• 5+ years of healthcare experience, including managed care, hospital, or physician practice settings
• 3+ years of managed care experience, with at least two years in Utilization Management
• Knowledge of CMS and/or NCQA standards, and proficiency with Microsoft Office applications