Clinical Quality Reviewer - REMOTE

• 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)

• U.S. Citizenship required

• Ability to obtain and maintain a Department of Defense (DoD) background clearance

• Strong analytical and critical thinking skills

• Excellent written communication 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

Technical Skills

• 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

Salary/Rate Range: $85,000 – $92,000 annually; Hourly Equivalent: Approximately $41 – $44/hour


Thank you for your interest in this opportunity. If you are selected to move forward in the process, we will contact you directly. If you do not hear from us, we encourage you to continue visiting our website for other roles that may be a good fit.