Job Description

Registered Nurse: Review and Evaluation

Are you a registered nurse ready to take your career in an exciting new directionone where your expertise truly makes a difference? Join Pennsylvania's premier Quality Improvement Organization and step into a dynamic role focused on advocacy and program integrity through compliance management. Here, you'll champion the needs of vulnerable populations, safeguard the quality of care, and influence healthcare outcomes on a meaningful scale. Enjoy the freedom of working from home, the flexibility and autonomy to manage your workday, and the opportunity for continuous professional growthall while being part of a passionate, mission-driven team dedicated to improving healthcare across the Commonwealth. In this rewarding role, you'll use your clinical knowledge outside of the traditional bedside setting to review and audit claims, support program integrity initiatives, and advocate for beneficiaries across the Commonwealth. You'll enjoy the flexibility of working from home, the autonomy to manage your work, and meaningful opportunities for professional growthall while contributing to a mission that truly matters.

What You'll Do:

• Conduct clinical reviews and ensure quality, appropriateness, and compliance with healthcare standards
• Support program integrity efforts by identifying trends, risks, and opportunities for improvement
• Advocate for beneficiaries, with a strong focus on protecting and improving care for vulnerable populations
• Apply nursing judgment to analyze medical records, documentation, and billing data
• Collaborate with interdisciplinary teams, providers, and stakeholders to promote best practices
• Contribute to quality improvement initiatives that strengthen healthcare delivery across Pennsylvania

What We're Looking For:

• Active, unrestricted Registered Nurse (RN) license
• Strong clinical background with the ability to apply nursing judgment analytically
• Interest in advocacy, quality improvement, and healthcare program integrity
• Excellent written and verbal communication skills
• Ability to work independently while managing multiple priorities
• Comfort with technology and electronic medical records
• Experience in utilization review, case management, quality improvement, compliance, or claims review is a plusbut not required.

Why Join Us:

• Mission-driven work with Pennsylvania's leading Quality Improvement Organization
• Make a real impact on healthcare quality and outcomes for vulnerable populations
• Remote work enjoy the convenience and balance of working from home
• Autonomy and flexibility in how you manage your workday
• Advocacy-focused role that values your nursing voice and expertise
• Career development opportunities to grow beyond traditional nursing roles
• Supportive, collaborative team culture committed to excellence and integrity

If you're a registered nurse seeking purpose-driven work, professional growth, and the flexibility to balance your life and careerthis is your opportunity. Apply today and help shape the future of healthcare quality in Pennsylvania.

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