Our Client, a Health Insurance company, is looking for a Nurse RN 3 for their Remote location. Responsibilities:

+ The Clinical Quality Review (CQR) team investigates and reviews potential quality of care issue (PQI) allegations or concerns arising from member grievances and internal referrals.

+ PQI reviews may confirm a quality problem that resulted in or had the potential for harm to the member and can lead to identification of provider opportunities for improvement related to practice patterns that are outside the framework of accepted standards.

+ The Clinical Quality Reviewer will report to the Manager, Clinical Quality Review.

+ In this role, you will be responsible for reviewing PQI cases per department protocols through various levels of review and executing follow up actions.

+ Analyze quality issues from both internal and external sources

+ Thoroughly investigate, apply critical thinking and clinical judgment t...