Clinical Quality Reviewer - REMOTE - RN - US Citizen Required

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

Job summary

Lynn Rodens is seeking an experienced RN for utilization review work. The role involves reviewing medical records, identifying quality and utilization issues, and drafting detailed case summaries.

Must possess strong writing skills and 3+ years of clinical experience in med/surg or behavioral health, with US citizenship and DoD clearance eligibility. Position is remote with AZ hours (typically first shift).

Qualifications

• Must have active, unrestricted RN license.
• Minimum 3+ years of clinical experience (med/surg and/or behavioral health).
• Strong clinical documentation and writing ability.
• U.S. Citizenship required and eligible for DoD background clearance.

Responsibilities

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

Skills

Clinical documentation

Writing ability

Data analysis

Analytical thinking

Education

Bachelor's degree in Nursing or healthcare-related field

Tools

InterQual

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


• U.S. Citizenship required


• 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)


• Write detailed case summaries + recommendations


• 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

• Clinical reviewer / utilization review nurse


• Experience with health plans or large healthcare systems


• Experience in Med-Surg in a hospital environment


• Strong analytical + writing skills