Registered Nurse (RN) Clinical Training & Quality Specialist
? Remote / Work From Home
? Michigan RN License Required
About the Opportunity
We are seeking an experienced Registered Nurse (RN) to support clinical quality, training, and utilization management initiatives in a fully remote environment. This role is responsible for staff education, quality reviews, audit coordination, training program development, and supporting accreditation and compliance efforts.
The ideal candidate will have a strong background in Care Management, Utilization Management, InterQual/MCG criteria, clinical training, and quality improvement.
Responsibilities
- Educate staff on managed care programs, processes, systems, and departmental procedures.
- Conduct quality reviews and audits of clinical cases.
- Develop, maintain, and update training materials, manuals, and educational resources.
- Mentor and support new hires throughout the onboarding and training process.
- Collaborate with leadership and subject matter experts to identify training needs and resources.
- Educate internal staff and external provider facilities on clinical policies, InterQual criteria, and departmental processes.
- Create and deliver training programs and educational packages.
- Participate in the development, testing, and implementation of new programs and systems.
- Analyze performance data and provide recommendations for improvement.
- Coordinate training logistics, class registration, scheduling, attendance tracking, and system access for new employees.
- Perform and coordinate internal and external audits.
- Support accreditation and regulatory compliance initiatives.
- Serve as a change champion by supporting new processes, systems, and tools.
- Travel occasionally as needed.
Required Qualifications
- Nursing Diploma or Associate Degree in Nursing required.
- Current, unrestricted Michigan Registered Nurse (RN) license required.
- Minimum 5 years of experience in healthcare-related fields.
- 3 to 5 years of experience in Care Management and/or Utilization Management.
- Strong knowledge of utilization management processes and InterQual and/or MCG criteria.
- Experience conducting clinical quality reviews and audits.
- Excellent written, verbal, analytical, and organizational skills.
- Ability to work independently and manage multiple priorities in a remote environment.
Preferred Qualifications
- Bachelor's Degree in Nursing (BSN) or related field.
- Case Management (CM) Certification.
- Experience with clinical training and staff development.
Technical Skills & Knowledge
- Microsoft Office Suite (Excel, Word, Teams)
- SharePoint
- Care Advance
- Virtual Desktop Applications (VDA)
- Electronic Health Records
- ICD-10 and CPT Coding
- CMS, NCQA, HIPAA, and other healthcare regulatory requirements
- Clinical assessment and intervention methodologies
Why Apply?
- Fully remote opportunity
- Meaningful impact on clinical quality and staff development
- Collaborative healthcare environment
- Opportunity to contribute to training, compliance, and process improvement initiatives
Apply today if you are a Michigan-licensed RN with experience in Care Management, Utilization Management, training, and quality improvement.
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