Clinical Review Nurse (RN) | MDS, Quality & Incident Management

Job Description

Job Description

Clinical Review Nurse (RN) | MDS, Quality & Incident Management

Pay: $43.00/hour
Schedule: Monday-Friday, 8:00 AM - 4:30 PM
Location: Remote/Hybrid with occasional travel as needed

Make an Impact in Long-Term Care Services

We are seeking a detail-oriented Registered Nurse (RN) with strong clinical judgment and exceptional computer skills to join a team focused on reviewing critical incidents, evaluating service plans, and helping ensure the health, safety, and well-being of individuals receiving long-term care services in community-based settings.

This role is ideal for a nurse with 3-5 years of experience who is looking to transition from direct patient care into a clinical review, quality, compliance, audit, or case management-focused position. Nurses with backgrounds in long-term care (LTC), skilled nursing, rehabilitation, hospital settings, utilization review, quality assurance, clinical auditing, or risk management are highly encouraged to apply.

What You'll Do

• Review and evaluate critical incident reports involving participants receiving long-term services and supports.
• Conduct clinical reviews to assess health, safety, welfare, and service appropriateness.
• Analyze medical records, nursing documentation, assessments, and care plans.
• Identify trends, patterns, and risk factors through incident and mortality reviews.
• Collaborate with social workers, care managers, protective services agencies, providers, and healthcare professionals.
• Ensure compliance with program regulations, policies, and established response timeframes.
• Provide guidance and technical assistance regarding incident reporting requirements and service plan expectations.
• Participate in investigations and recommend appropriate follow-up actions when warranted.
• Assist with program quality improvement initiatives and evaluation of community-based services.
• Prepare written findings, reports, and recommendations.
• Support hearings, appeals, and stakeholder inquiries as needed.

Ideal Background

We are targeting nurses with approximately 3-5 years of clinical nursing experience who possess strong analytical and documentation review skills.

Experience in any of the following is highly preferred:

• Long-Term Care (LTC)
• Skilled Nursing Facilities (SNF)
• Hospital Medical-Surgical Units
• Case Management
• Utilization Review
• Quality Assurance
• Risk Management
• Clinical Compliance
• Home Health
• MDS
• Care Coordination
• Adult or Geriatric Care

Bonus Experience

Candidates with experience in any of the following will stand out:

• Hospital quality audits
• Clinical chart auditing
• Regulatory compliance reviews
• Incident investigations
• Risk assessment
• Mortality reviews
• Quality improvement initiatives
• CMS or Medicaid program knowledge

Required Qualifications

• Active Registered Nurse (RN) license in good standing.
• 3-5 years of nursing experience.
• Strong understanding of medical terminology, disease processes, and treatment modalities.
• Excellent critical thinking and clinical decision-making abilities.
• Strong written and verbal communication skills.
• Ability to work independently and manage multiple priorities.
• Advanced computer proficiency, including Microsoft Office Suite (Word, Excel, Outlook, and Teams).
• Comfortable working in a highly documented, fast-paced, remote environment.

Preferred Qualifications

• Bachelor's degree in Nursing (BSN).
• Experience with long-term services and supports programs.
• Prior experience reviewing clinical documentation and service plans.
• Knowledge of Medicaid, waiver programs, or community-based healthcare services.
• Experience presenting findings and recommendations to stakeholders.

What Success Looks Like

The successful candidate will be highly organized, investigative in nature, and comfortable reviewing complex clinical situations to ensure appropriate services are being delivered. They will possess strong attention to detail, excellent documentation skills, and the ability to identify risks, trends, and opportunities for improved participant outcomes.

This is an excellent opportunity for a nurse seeking a stable Monday-Friday schedule while utilizing clinical expertise in a quality, compliance, and review-focused environment.

Contact: Katherine Skelton

View phone number on ziprecruiter.com