Clinical Quality Coordinator RN - PRIDE Health : Job Details

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