Nurse Quality Analyst - Remote

Nurse Quality Analyst - Remote plus $10K Sign on Bonus

Job Summary
Join to apply for the Nurse Quality Analyst - Remote plus $10K Sign on Bonus role at Conifer Health Solutions

Key Responsibilities

• Recover revenue associated with disputed/denied clinical claims and prepare documentation for industry‑accepted clinical appeals.
• Perform retrospective medical necessity reviews to determine appellate potential of clinical disputes and conduct fact‑based narrative appeals using Inter Qual® criteria (Acute, Procedures, etc).
• Critically think and follow documented processes for supporting the clinical appellate process.
• Maintain productivity and quality goals and work cases in a timely manner based on payor guidelines.
• Utilize electronic tools (ACE, nThrive, eCARE, Authorization log, Inter Qual®, VI, HPF) and Microsoft Office; possess basic patient accounting knowledge (UB92/UB04, EOB components).
• Serve as a resource to non‑clinical personnel, provide solutions to leadership, assist in policy development, and support Law Department activities including mediation hearings.

Knowledge, Skills, and Abilities

• Proficiency with Inter Qual® criteria and application of medical necessity reviews.
• Excellent written, verbal, and professional letter‑writing skills.
• Independent critical thinker who can make decisions about medical necessity.
• Professional interaction with clinical and non‑clinical partners.
• Knowledge of managed‑care contracts and reimbursement matrices.
• Ability to multitask and conduct research on appellate guidelines and regulatory processes.
• Research proficiency on off‑label medication use.

Required Education and Experience

• Active Registered Nursing (RN) license.
• Minimum three (3) years of recent acute‑care experience in a facility setting.
• Preferred:
  Medical‑surgical/critical‑care experience, at least two (2) years of utilization review or case management experience, and experience with Inter Qual® products.

Certifications and Licenses

• Current, valid RN licensure.
• Preferred:
  Certified Case Manager (CCM) or Certified Professional in Utilization Review/Management (CPUR/CPUM/CPHM).

Physical Demands

• Lift 15–20 lbs.
• Travel approximately 10% of the time to various sites.
• Sit and work at a computer for prolonged periods.

Work Environment

• Typical office setting with desk, chair, and standard office equipment.

Compensation

• Hourly pay: $30.85 – $46.28, varying by location, qualifications, and experience.
• Eligible for a signing bonus subject to employment status.
• Observed holidays receive time and a half.

Benefits

• Medical, dental, vision, disability, and life insurance.
• Paid time off: minimum 12 days per year, accrue at ~1.84 hours per 40 hours worked.
• 401(k) with up to 6% employer match.
• 10 paid holidays per year.
• Health savings accounts and flexible spending accounts.
• Employee Assistance Program, employee discount program.
• Voluntary benefits: pet insurance, legal insurance, accident and critical illness insurance, long‑term care, elder & childcare, AD&D, auto & home insurance.
• Colorado employees receive paid leave per Colorado’s Healthy Families and Workplaces Act.

EEO Statement

Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.