Clinical Quality Reviewer - REMOTE - LCSW OR RN - US Citizen Required

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

Job summary

TEEMA is seeking an experienced RN for a remote, healthcare quality role. You will review medical records for quality, safety, and utilization, and identify PQIs while ensuring regulatory standards are met.

Ideal candidates have 3+ years in Med-Surg or behavioral health, strong documentation skills, and a DoD background clearance. Must align with AZ hours (first shift) and be eligible for DoD checks. Remote position with state sourcing constraints.

Qualifications

• Active, unrestricted RN license.
• Minimum 3+ years clinical experience in med/surg and/or behavioral health.
• Strong clinical documentation and writing ability.
• Must be eligible for DoD background clearance.

Responsibilities

• Review medical records for quality, safety, and utilization.
• Identify Potential Quality Issues (PQIs).
• Support peer review and quality improvement initiatives.
• Collaborate with Medical Directors.
• Analyze trends and recommend improvements.
• Ensure compliance with regulatory and program standards.

Skills

RN license

Clinical documentation

DoD background clearance

Quality review

Data analysis

Education

Bachelor’s degree in Nursing or healthcare-related field

Tools

InterQual criteria

Job description

Compensation: $85,000 – $92,000
Hourly Equivalent: ~$41–$44/hr

Location: Remote
Schedule: Must work AZ hours (typically 1st shift)

CLIENT NOTES / EXPECTATIONS

Candidates must meet required AND preferred qualifications

APPROVED WORK STATES (RECRUITING GUIDELINES)

AK, AR, AZ, CO, DC, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NC, ND, NE, NM, NV, OK, OR, SC, SD, TN, TX, UT, VA, WA, WI, WY

Only source candidates in these states

REQUIRED QUALIFICATIONS (MUST HAVE)

Active, unrestricted license:

RN

Minimum 3+ years clinical experience
(med/surg and/or behavioral health)

Strong clinical documentation + writing ability

Must be eligible for DoD background clearance

PREFERRED QUALIFICATIONS (HIGHLY DESIRED)

Clinical Quality / Utilization Review / Case Review experience

Experience with federal or government healthcare programs

InterQual or similar clinical criteria tools

Data analysis / reporting exposure

Bachelor’s degree in Nursing or healthcare-related field

CORE RESPONSIBILITIES (WHAT THEY ACTUALLY DO)

Review medical records for quality, safety, and utilization issues

Identify Potential Quality Issues (PQIs)

Support peer review + quality improvement initiatives

Collaborate with Medical Directors

Analyze trends and recommend improvements

Ensure compliance with regulatory and program standards

IDEAL CANDIDATE PROFILE

Experience with health plans or large healthcare systems

Experience in Med-Surg in a hospital environment