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.
Clinical Quality Reviewer - REMOTE • Vancouver, BC
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