Medica

Medica, a nonprofit health plan, seeks a Clinical Quality Review III (RN and Certified Coder) to conduct medical record reviews, data collection, and clinical audits across its network. You will assess documentation accuracy, adherence to clinical standards, and compliance with HEDIS, STARS, CMS Cost Audit, and RADV, while sharing expertise to strengthen quality review processes. This remote role requires strong nursing and coding skills, 5+ years in quality reviews, and the ability to educate #J-18808-Ljbffr

Medica is seeking a Clinical Quality Review Nurse III to conduct medical record reviews and audits across its network in a remote capacity. The role requires an active RN license and a certified coding credential, along with experience in data collection and quality measurement. You will ensure documentation accuracy, alignment with regulatory standards (HEDIS, CMS, NCQA), and support education for providers. #J-18808-Ljbffr