Pride Health
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
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