Clinical Quality Reviewer - REMOTE - LCSW OR RN - US Citizen Required

Compensation: $85,000 – $92,000

Hourly Equivalent: ~$41–$44/hr

Location: Remote

Schedule: Must work AZ hours (typically 1st shift)

CLIENT NOTES / EXPECTATIONS

• Candidates must meet required AND preferred qualifications

APPROVED WORK STATES (RECRUITING GUIDELINES)

AK, AR, AZ, CO, DC, FL, HI, IA, ID, 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

Required Qualifications (must Have)

• 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

Preferred Qualifications (highly Desired)

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

Core Responsibilities (what They Actually Do)

• 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

IDEAL CANDIDATE PROFILE

• 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