Clinical Quality Review Nurse

TEEMA; Phoenix (AZ); Remote; USD 85,000 - 92,000; Full time

Job summary

TEEMA is partnering with a leading organization to recruit a Clinical Quality Reviewer (RN or LCSW) for USA-remote work in approved states. The role focuses on reviewing clinical cases, identifying quality, safety, and utilization concerns, and supporting improvement across a complex healthcare network.

You will collaborate with Medical Directors, participate in quality committees, and ensure regulatory compliance.

Qualifications

• Active, unrestricted RN or LCSW license.
• Minimum 3+ years of clinical experience (medical/surgical and/or behavioral health).
• Ability to obtain and maintain a DoD background clearance.
• Strong analytical and critical thinking skills.

Responsibilities

• 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.

Skills

Clinical judgment

Analytical thinking

Regulatory/compliance awareness

Communication skills

Education

Bachelor's degree in Nursing or healthcare field

Tools

Microsoft Word

Excel

EMR systems

Job description

Job Title: CLINICAL QUALITY REVIEWER (RN or LCSW) Location: USA- Remote in approved states

Overview: TEEMA 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, safety, and utilization 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)
• Ability to obtain and maintain a Department of Defense (DoD) background clearance
• Strong analytical and critical thinking 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