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

RTNZYmxsdU56bDBVMFZXdHFrMDdOSWRC
  • 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,

Similar Jobs

Waypoint Human Capital

Cyber Operations SME Job at Waypoint Human Capital

 ...policies and procedures Responsibilities: Establish plan, prepare, and present briefings, reports, and presentations to CIO, CISO, and SOC leadership, senior NRO decision-makers, security staff, and other US Government consumers in a manner that meets their specified... 

Tri-BAR Transportation, INC

CDL A Truck Driver Job at Tri-BAR Transportation, INC

 ...freight, contributing to the success and satisfaction of our customers. Role Description This is a full-time role for a CDL A Truck Driver located in Prairieville, LA. The CDL A Truck Driver will be responsible for transporting industrial freight and hazardous... 

Philip Morris International

Process Control Lead Job at Philip Morris International

 ...oriented, a quick learner and have attention for detail. Position in not a remote position and will require to be onsite 5 days week Must be able to commute to surrounding area of the DIA Must be a U.S. Citizen as no sponsorship is available. #PMIUS #LI-PS1... 

Encore Leadership Advisors

Preschool Teacher Job at Encore Leadership Advisors

$2000 sign on bonus Under the Center Director/Assistant Director/Site Coordinator, the Preschool Teacher provides effective instructional strategies that are developmentally appropriate for 3-5 year old's. Through classroom management, provides a classroom environment... 

Advocate Health Care

Manager Inpatient Care Management Job at Advocate Health Care

 ...Manager Inpatient Care Management Advocate Lutheran General Hospital 1775 Dempster St., Park Ridge, IL 60068 Advocate Health Illinois Division Job ID # R137619 Exempt Full Time, Monday through Friday 0800 1630 plus after hour calls Salary Range...