Clinical Quality Coordinator RN Job at Pride Health, Bronx, NY

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  • Pride Health
  • Bronx, NY

Job Description

Job Title: RN Clinical Quality Coordinator – Managed Long-Term Care (MLTC)

Location: Bronx, NY (Remote after possible onsite training)

Job Type: Full Time/Permanent

Join a dedicated healthcare team focused on improving quality of care for older adults in a managed long-term care setting. This role offers an immediate opportunity to make a meaningful impact by supporting quality assurance and performance improvement activities.

Responsibilities:

  • Analyze clinical data to identify trends, opportunities, and recommend improvements
  • Serve as a subject matter expert for clinical quality within the organization
  • Process all Appeals within regulatory timelines, including verbal and written notifications
  • Investigate clinical grievances and quality of care concerns across product lines
  • Coordinate with staff to ensure timely completion and submission of grievance, appeal, incident, and quality improvement documentation
  • Collaborate with Quality Assurance and IT teams for clinical data analysis

Qualifications:

  • Bachelor’s degree in nursing required
  • Current valid Registered Professional Nurse license in New York State
  • Minimum of 2 years’ experience in managed care, including Care Management, Quality, Utilization Management, or Grievance and Appeals
  • Strong knowledge of Medicare and Medicaid regulations
  • Excellent analytical, organizational, and communication skills
  • Proficiency with Microsoft Word, PowerPoint, and Excel
  • Ability to work independently and solve problems effectively

Important Details:

Compensation: $113,000 - $118,000 per year (based on experience)

Benefits: Health insurance, Retirement plans, Paid time off, Professional development opportunities

Job Tags

Permanent employment, Full time, Immediate start, Remote work,

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