Senior Clinical Quality Nurse

Location: Remote for candidates residing in Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Michigan, Missouri, Nebraska, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, or Virginia. Occasional travel may be required for team meetings and company events.

Salary: $83,628–$109,761 per year in California, Connecticut, New Jersey, New York, and Washington; $75,265–$98,785 per year in other locations.

Company

hirify.global is a health insurance company built around a full-stack technology platform and member-focused healthcare services.

What you will do

• Perform quality audits of clinical documentation across multiple clinical departments.
• Develop audit surveys, rubrics, and tracking mechanisms aligned with departmental goals and regulatory accreditation requirements.
• Support organizational readiness for NCQA and other regulatory audits.
• Conduct delegate oversight audits, prepare result summaries, present findings, and help develop corrective action plans.
• Provide feedback, coaching, and training on clinical workflows, quality practices, and audit standards.
• Analyze quality data and trends, participate in calibration and interrater reliability sessions, and report findings to stakeholders.

Requirements

• Active, unrestricted Registered Nurse license in the state of residence, with willingness to obtain additional licenses as needed.
• At least 2 years of Registered Nurse experience.
• At least 2 years of experience working in a clinical care setting.
• At least 1 year of utilization review experience at a managed care plan or provider organization.
• Must reside in one of the listed eligible U.S. states.

Nice to have

• Health plan case management or healthcare quality assurance experience.
• Experience auditing medical records and evaluating clinical information.
• Bachelor’s degree from an accredited university; BSN preferred.
• Knowledge of health insurance, Medicare, Individual Marketplace insurance, NCQA standards, HEDIS measures, and regulatory requirements.
• CCM or MCG certification, data analysis experience, and proficiency with Google applications and communication platforms.

Culture & Benefits

• Full-time employment with medical, dental, and vision benefits.
• 11 paid holidays, paid sick time, paid parental leave, and paid wellness time.
• 401(k) plan participation, life and disability insurance, and wellness reimbursements.
• Unlimited vacation program and annual performance bonuses.
• Equal opportunity environment focused on belonging and support.