Remote RN Quality of Care & Clinical Review
HCSC
Health Care Service Corporation seeks a Quality of Care (QOC) Nurse to review and investigate potential quality of care issues in a timely manner. This role supports QA activities in line with CMS and NCQA requirements, under the supervision of the QOC Manager.
Ideal candidates bring an unrestricted RN license, at least 5 years of healthcare process experience, and strong analytical and communication skills. The role can be performed remotely within the continental United States.
#J-18808-Ljbffr$69.8k - $125.9k
...the supervision of the Quality of Care (QOC) Manager, the QOC Nurse conducts the review and investigation of potential... ...~ Registered Nurse (RN) with unrestricted... ...to assess and judge the clinical performance of physicians... ...available This is a remote role #LI- remote...Remote workFull time- ...Comagine Health is seeking a Clinical Reviewer (RN) remotely to support Washington state contracts. The role evaluates medical necessity and quality of care, collaborating with physician consultants and internal teams to ensure compliant, evidence-based decisions. The...Remote work
- ...in Washington State is seeking an experienced Registered Nurse to join our remote Clinical Reviewer team. The role focuses on assessing medical necessity, appropriateness, and quality of care through prospective, concurrent, and retrospective reviews for inpatient and...Remote jobContract workWork from home
- ...experienced Registered Nurse to serve as Clinical Reviewer in a remote, Washington-based role. You... ...medical necessity and the quality of healthcare services via... ...reviews, supporting evidence-based care decisions. The ideal candidate has RN licensure in Washington and at...Remote job
- ...seeking an Episodic Care Manager to join the Commercial Clinical Utilization Management team. The role reviews medical necessity and... ...providers to ensure quality and cost-efficiency.... ...include an RN with 3 years of experience... ...person collaboration and remote options. #J-18808-...Remote workFlexible hours
$62.7k - $100.4k
Clinical Care Reviewer II-RN with Compact License Apply ( remote type Remote locations Remote time type Full time posted on Posted Yesterday job requisition... ...and accreditation standards Identify and refer quality issues to Quality Improvement Identify and...Remote workHourly payFull timeWork at office- ...Telenett is seeking a Remote Utilization Review Nurse to review medical records... ...medical necessity and care appropriateness. You... ...care plans and ensure high-quality, cost-efficient services... ...candidates have a Texas RN license, 3+ years of clinical experience, strong...Remote workHome office
- ...Lynn Rodens is seeking a skilled Clinical Reviewer/Nurse for a remote role aligned with AZ hours. The position requires active RN license, U.S. citizenship, 3+ years in med/surg... ...healthcare systems. This role focuses on quality review, PQIs, and collaborating with Medical...Remote work
- Comagine Health is seeking an RN to perform Clinical Review work and QIDP reviews. The team member will serve... ...experience. The position is primarily remote, with licensing in Alabama and ongoing... ...Minimum of 3 years of direct patient care, a BSN, and an active Alabama RN...Remote work
- Exceptional care starts with exceptional people. For us, this... ...the CDI Leadership. Acts as a clinical and technical resource to the... ...intervals; facilitates special record reviews, projects and other customer... ...you are interested in is remote or on-site. Individuals who...Remote workWork experience placement
$85k - $92k
...Equivalent: ~$41–$44/hr Location: Remote Schedule: Must work AZ hours (... ...Active, unrestricted license: RN Minimum 3+ years clinical experience (med/surg and/or... ...(highly Desired) Clinical Quality / Utilization Review / Case Review experience Experience...Remote workHourly payDay shift$88.85k
...Utilization Management Clinical Quality Nurse Reviewer RN IISalary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles...- ...TEEMA Group is seeking a Clinical Quality Reviewer (RN or LCSW) for remote work in approved states. This role focuses on reviewing clinical cases, identifying quality or safety concerns, and supporting quality improvement initiatives across a healthcare network. The...Remote work
- ...Spring Health is seeking a Clinical Quality Manager - Medication Care to uphold top-tier quality across Medication... ...care complaints, manage peer reviews, and partner with clinical leadership... ...workflow efficiency. The role is fully remote in the U.S., with occasional travel...Remote work
$45 - $50 per hour
...looking for a dedicated Registered Nurse Clinical Reviewer for a fully remote position in New York. This role involves conducting utilization and quality reviews and contributing to clinical... ...programs with an active New York RN license. #J-18808-Ljbffr kozmetickesluzby...Remote jobHourly pay- A-Line Staffing Solutions is seeking a Clinical Review Nurse to perform concurrent reviews of patient care for quality and compliance. You will collaborate with physicians and care teams to assess treatment plans and document findings. You will analyze patient data and...
$64.5k - $92.2k
Gainwell Technologies LLC is seeking a Clinical Quality Nurse Reviewer, Sr. Specialist for a remote role. You will conduct quality assurance audits of clinical staff... ...and guidelines. The position requires an active RN license, with 5+ years clinical experience preferred...Remote work$64.5k - $92.2k
...Gainwell Technologies LLC is seeking a Clinical Quality Nurse Reviewer, Sr. Specialist to perform ongoing quality assurance audits on clinical staff. This full-time remote position requires an active RN license and clinical experience in healthcare. Responsibilities...Remote workFull time- ...Health Partners Inc., is hiring a Utilization Review Nurse in Franklin, TN. You will assess medical necessity and quality of care through pre-service, concurrent, and... ...patient outcomes. The role requires an active RN license, an Associates or higher in Nursing,...Remote work
- ...Seeking a full-time remote Compact Licensed Clinical Care Reviewer II, the role involves processing medical necessity... ...and coordinate member care Identify quality issues and refer members for Care... ...an accredited registered nursing (RN) degree program Current, unrestricted...Remote workFull time
- ...mission centers on delivering only the best quality talent, the first time and every time.... ...areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy, and... ...Our client is looking to hire a Clinical Care Reviewer UM. The primary purpose of the...Work at office
- ...LPN – Clinical Quality & Care Coordinator Work Location: Brooklyn, NY 11218 Work Setting: Onsite (Monday – Thursday, Friday Remote) Work hours: 9AM -5PM EST Work Type: Temporary Role (3 months... ...and closing care gaps, reviewing clinical documentation, conducting...Remote workTemporary workWork at officeMonday to Friday
- ...Prime option in New York seeks an experienced Clinical Quality Reviewer. The role conducts post-service in-depth clinical reviews across care settings, using clinical expertise to... ...departments. The ideal candidate holds an RN or LPN license with 1–3 years of healthcare...Remote work
- ...Clinical Reviewer – Registered Nurse (RN) Comagine Health | Washington State | Remote / Work From Home Department: Care Management Contract: Washington Labor & Industries (L&I) Location... ...in clinical review and healthcare quality. Why Comagine Health? At...Remote workFull timeContract workLocal areaWork from homeHome office
- Clinical Care Reviewer UM (RN/LPN)Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional... ...in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality...Work at office
$85k - $92k
...Job Title: CLINICAL QUALITY REVIEWER (RN or LCSW) Job ID: 90896 Location: USA- Remote in approved states Overview: We are partnering with a leading organization... ...trends and assist in identifying patterns in care delivery and outcomes Collaborate with clinical...Remote workHourly payWork at officeHome office- ...Molina Healthcare is seeking a Care Review Clinician (RN or LPN) for a remote, full-time position operating 8a-5p... ...through Friday. You will support clinical member services review processes,... ...guidelines and policies to promote quality and cost-effective care. In this...Remote workFull timeMonday to Friday
- ...Integrated Resources, Inc. is seeking a Clinical Care Reviewer to perform medical necessity reviews as directed by the unit Supervisor. The... ...clinical experience, offering a vital opportunity to contribute to care quality and service approval processes. #J-18808-Ljbffr...
- ...Managed Medical Review Organization is seeking a licensed RN to join our team for remote, home-office work. This role emphasizes telephonic customer service, accurate documentation, and clinical review of medical records with no face-to-face patient contact. Applicants...Remote workWork at officeWork from homeHome office
$93.35k - $132.43k
...Overview: Sentara Health Plans is hiring a Clinical Claims Reviewer/ RN - Remote! Status: Full-time, permanent... ...Insurance (BOI), National Committee for Quality Assurance (NCQA), Centers for... ...Required. Must possess 3 years of acute care clinical experience. Previous...Remote workPermanent employmentFull timeTemporary workWork at officeShift work
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