Clinical Quality Reviewer - REMOTE - LCSW OR RN

Compensation: $85,000 – $92,000

Hourly Equivalent: ~$41–$44/hr

Location:

Remote

Schedule:

Must work AZ hours (typically 1st shift)

• Candidates must meet required AND preferred qualifications

AK, AR, AZ, CO, DC, FL, HI, IA, , IL, KS, LA, MD, MN, MO, MT, NC, ND, NE, NM, NV, OK, OR, SC, SD, TN, TX, UT, VA, WA, WI, WY

Only source candidates in these states

• Active, unrestricted license:
  • RN
• Minimum 3+ years clinical experience (med/surg and/or behavioral health)
• Strong clinical documentation + writing ability
• U.S. Citizenship required
• Must be eligible for DoD background clearance

• Clinical Quality / Utilization Review / Case Review experience
• Experience with federal or government healthcare programs
• Inter Qual or similar clinical criteria tools
• Data analysis / reporting exposure
• Bachelor’s degree in Nursing or healthcare-related field

• Review medical records for quality, safety, and utilization issues
• Identify Potential Quality Issues (PQIs)
• Write detailed case summaries + recommendations
• Support peer review + quality improvement initiatives
• Collaborate with Medical Directors
• Analyze trends and recommend improvements
• Ensure compliance with regulatory and program standards

• Clinical reviewer / utilization review nurse
• Experience with health plans or large healthcare systems
• Experience in Med-Surg in a hospital environment
• Strong analytical + writing skills