Clinical Quality Review Nurse III

The Clinical Quality Review III role supports quality performance by conducting medical record reviews, data collection, and clinical audits across Medica’s network. The position evaluates documentation accuracy, adherence to clinical standards, and compliance with regulatory and accreditation requirements, including HEDIS, STARS, CMS Cost Audit, and RADV.

It applies advanced nursing and coding expertise to identify improvement opportunities and ensure the reliability of quality outcomes. This role also serves as a resource to others by sharing clinical and coding knowledge that strengthens quality review processes. RN and Certified Coder required. Performs other duties as assigned.