Registered Nurse: Review and EvaluationAre you a registered nurse ready to take your career in an exciting new direction—one 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 growth—all 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 growth—all while contributing to a mission that truly matters.What You'll Do:Conduct clinical reviews and ensure quality, appropriateness, and compliance with healthcare standardsSupport program integrity efforts by identifying trends, risks, and opportunities for improvementAdvocate for beneficiaries, with a strong focus on protecting and improving care for vulnerable populationsApply nursing judgment to analyze medical records, documentation, and billing dataCollaborate with interdisciplinary teams, providers, and stakeholders to promote best practicesContribute to quality improvement initiatives that strengthen healthcare delivery across PennsylvaniaWhat We're Looking For:Active, unrestricted Registered Nurse (RN) licenseStrong clinical background with the ability to apply nursing judgment analyticallyInterest in advocacy, quality improvement, and healthcare program integrityExcellent written and verbal communication skillsAbility to work independently while managing multiple prioritiesComfort with technology and electronic medical recordsExperience in utilization review, case management, quality improvement, compliance, or claims review is a plus—but not required.Why Join Us:Mission-driven work with Pennsylvania's leading Quality Improvement OrganizationMake a real impact on healthcare quality and outcomes for vulnerable populationsRemote work – enjoy the convenience and balance of working from homeAutonomy and flexibility in how you manage your workdayAdvocacy-focused role that values your nursing voice and expertiseCareer development opportunities to grow beyond traditional nursing rolesSupportive, collaborative team culture committed to excellence and integrityIf you're a registered nurse seeking purpose-driven work, professional growth, and the flexibility to balance your life and career—this is your opportunity. Apply today and help shape the future of healthcare quality in Pennsylvania.
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