REMOTE RN - Quality Review

OverviewTEEMA is 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 doingReview medical records to identify potential quality, safety, and utilization concernsConduct detailed case analysis and prepare clear, well-documented summaries and recommendationsSupport peer review processes and quality improvement initiativesAnalyze trends and assist in identifying patterns in care delivery and outcomesCollaborate with clinical leadership, including Medical Directors, to review findingsParticipate in quality committees and performance improvement effortsEnsure compliance with regulatory requirements and program standardsCoordinate with cross-functional teams such as case management, care coordination, and program integrityWhat you must haveActive, 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 clearanceStrong analytical and critical thinking skillsNice to haveBachelor's degree in Nursing or healthcare-related fieldExperience in clinical quality, utilization review, or case reviewFamiliarity with federal or government healthcare programsExperience with clinical criteria tools (InterQual or similar)Exposure to healthcare data analysis or reportingTechnical SkillsProficiency with Microsoft Office (Word, Excel, Outlook)Comfortable working across multiple systems and electronic medical recordsWhat makes you successfulStrong clinical judgment and attention to detailAbility to work independently and manage multiple prioritiesAnalytical mindset with problem-solving abilityClear and professional communication skillsComfortable working in a structured, compliance-driven environmentOther InformationRemote or onsite depending on business needsMust have a secure home office setup if remoteOccasional extended hours may be requiredSalary / Rate Range$85,000 – $92,000 annually; Hourly Equivalent: Approximately $41 – $44/hourJ-18808-Ljbffr