Healthmap Solutions · 1 day ago
RN Quality Assurance Reviewer (100% Remote)
United States
Full-time
Remote
Mid Level
3+ years expHealthmap Solutions is a company focused on specialty health management, particularly in kidney health populations. The Registered Nurse, Quality Assurance Reviewer will be responsible for completing quality reviews for Clinical Services and Provider Relations teams, supporting Quality Improvement Programs related to accreditation and regulatory standards.
BiotechnologyHealth CareMedical
Responsibilities
Audit clinical documentation and audit calls to provide feedback ensuring that delegation requirements related to NCQA, URAC, and client are met
Ensure files comply with federal, state, local CMS accreditation standards
Support clinical operations in pre-delegation, delegation, and accreditation reviews
Provide support to clinical operations in auditing clinical documentation and member facing calls as part of clinical excellence review initiatives
Maintain all required quality, organization, and project documentation
Prepare and audit files based on regulatory, accreditation, and client requirements in a timely manner to provide key stakeholders an opportunity to correct deficiencies before external audits
Prepare and deliver weekly reporting statistics of audit activities and outcomes
Assist with health plan interface and participate in prep for external audits of clinical program
Be a subject matter expert who is able to provide innovative solutions to problems and assist quality improvement initiatives
Navigate technical applications – Excel, Outlook, PowerPoint, and Word
Participate in the quality testing of platform and products enhancements of our electronic medical records system
Qualification
Required
Must be bilingual English/Spanish
RN or LPN licensure and a Bachelor's degree required (8+ years of clinical quality improvement experience will be considered in lieu of degree and/or RN/LPN licensure)
Three (3) years of healthcare experience in a care management or quality management setting required
Experience working in electronic medical records, generating reports and analyzing data required
Effective verbal and written communication
Advocate and energize a culture of collaboration, positivity, and motivation
Performance metrics driven
Ability to manage multiple concurrent deadlines
Strong organizational skills and attention to detail
Must be proficient in Microsoft Office: Outlook, Word, Excel, PowerPoint
Preferred
Knowledge of regulatory, CMS and accreditation agencies (NCQA and/or URAC) strongly preferred
Knowledge of Care Management and Managed Care setting strongly preferred
Experience monitoring calls of a clinical staff preferred
Company
Healthmap Solutions
Healthmap Solutions is a health management company that focuses on progressive diseases.
201-500 employees
H1B Sponsorship
Healthmap Solutions has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (4)
2024 (2)
2023 (1)
2022 (2)
Funding
Current Stage
Growth StageTotal Funding
$225.6MKey Investors
WindRose Health Investors
2023-08-01Private Equity· $100M
2022-05-02Series Unknown· $35M
2019-06-18Private Equity· $85M
Leadership Team
Richard Popiel
Chief Medical Officer
Recent News
Healthmap Solutions
2025-11-04
healthmapsolutions.com
2025-02-03
Company data provided by crunchbase