RN Clinical Quality Reviewer

Overview We are partnering with a leading organization supporting a large-scale federal healthcare program to identify a Clinical Quality Reviewer. This role focuses on reviewing clinical cases, identifying potential quality or safety concerns, and supporting quality improvement initiatives across a complex healthcare delivery network. This is an excellent opportunity for a licensed clinical professional with experience in clinical review, utilization management, or healthcare quality within health plans, hospital systems, or government-supported programs. What you will be doing Review medical records to identify potential quality, safety, and utilization concerns Conduct detailed case analysis and prepare clear, well-documented summaries and recommendations Support peer review processes and quality improvement initiatives Analyze trends and assist in identifying patterns in care delivery and outcomes Collaborate with clinical leadership, including Medical Directors, to review findings Participate in quality committees and performance improvement efforts Ensure compliance with regulatory requirements and program standards Coordinate with cross-functional teams such as case management, care coordination, and program integrity What you must have Active, unrestricted license as a Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) Minimum 3+ years of clinical experience (medical/surgical and/or behavioral health) Ability to obtain and maintain a Department of Defense (DoD) background clearance Strong analytical and critical thinking skills Nice to have Bachelor’s degree in Nursing or healthcare-related field Experience in clinical quality, utilization review, or case review Familiarity with federal or government healthcare programs Experience with clinical criteria tools (InterQual or similar) Exposure to healthcare data analysis or reporting Proficiency with Microsoft Office (Word, Excel, Outlook) Comfortable working across multiple systems and electronic medical records What makes you successful Strong clinical judgment and attention to detail Ability to work independently and manage multiple priorities Analytical mindset with problem-solving ability Clear and professional communication skills Comfortable working in a structured, compliance-driven environment Other Information Remote or onsite depending on business needs Must have a secure home office setup if remote Occasional extended hours may be required #J-18808-Ljbffr