Clinical Quality Reviewer – REMOTE
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 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 doing:
- 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