Clinical Readmission Review Quality Analyst

EXL; Oregon; Hybrid; USD 60,000 - 99,000; Full time

Job summary

EXL is hiring a Clinical Readmission Review Quality Analyst to oversee audit accuracy, documentation quality, and clinical rationale across remote reads. The role includes coaching auditors, analyzing trends, and recommending process improvements while ensuring compliance with HIPAA and program requirements.

The position offers a salary range of $60,100–$98,700 with up to 10% travel, remote US-based, and benefits as part of EXL’s offerings.

Qualifications

• Active, unrestricted RN license in the United States is required.
• 5+ years of acute care nursing, utilization review, clinical auditing, readmission review, quality review, or related healthcare experience preferred.
• Prior readmission, quality control, secondary review or peer review experience is a plus.
• Knowledge of potentially preventable readmission concepts, readmission drivers, discharge planning, transitions of care, and medical necessity preferred.
• Strong written and verbal communication, analytical skills, and attention to detail.

Responsibilities

• Apply clinical judgment to ensure accuracy and consistency of audits.
• Perform quality reviews of random and targeted samples to validate findings and supporting documentation.
• Follow approved sampling methodology for quality reviews.
• Apply quality scoring criteria to evaluate accuracy and documentation.
• Confirm readmission determinations are supported by the medical record and client requirements.
• Review audit documentation for clarity, completeness, and evidence-based support.
• Provide feedback and coaching to auditors based on quality outcomes.

Skills

Clinical Readmission Review

Quality Control Review

Audit Sampling

Medical Record Review

Clinical Judgment

Quality Feedback

Calibration

Trend Identification

Written Communication

HIPAA Compliance

Education

RN license (US)

Associate's or Bachelor's degree

Tools

Excel

Word

Outlook

OneNote

Job description

The Clinical Readmission Review Quality Analyst oversees work performed by Clinical Readmission Review Auditors to ensure EXL's standard of accuracy, consistency, and documentation quality is met. The analyst performs quality reviews of random and targeted samples of completed readmission audits and applies expert clinical knowledge when reviewing inpatient medical records to confirm that audit determinations are clinically supported, appropriately documented, aligned with program requirements, and supported by clear rationale. This role identifies quality trends, provides feedback and coaching support to auditors, supports calibration, and recommends process improvements to strengthen overall audit quality and performance.

Salary Range: $60,100 - $98,700 | Location: 100% Remote, U.S.-based | Travel: Up to 10% annually A quality review, clinical audit, or written documentation assessment may be included as part of the interview process. For more information on benefits and what we offer please visit us at us-careers-and-benefits

Responsibilities

• Apply clinical judgment and readmission review knowledge to ensure the accuracy and consistency of completed Clinical Readmission Review audits.
• Perform quality reviews of random and targeted samples of Clinical Readmission Review Auditor work to validate findings, no-findings, clinical rationale, and supporting documentation.
• Follow approved sampling methodology for random, targeted, and follow-up quality reviews.
• Apply established quality scoring criteria to evaluate audit accuracy, documentation quality, and adherence to program expectations.
• Confirm that readmission determinations are supported by the medical record, applicable clinical criteria, client requirements, and internal procedures.
• Review audit documentation for clarity, completeness, grammar, evidence-based support, and alignment with EXL quality expectations.
• Provide feedback and coaching support to Clinical Readmission Review Auditors based on quality review outcomes, including clear coaching points and examples when needed.
• Utilize extensive clinical and industry knowledge to identify audit trends, missed opportunities, recurring errors, and potential referrals for additional review or escalation.
• Provide root cause analysis on quality errors and recommend corrective actions to improve audit accuracy, documentation quality, and performance.
• Support calibration discussions, quality monitoring, standard operating procedure updates, and training opportunities to promote consistent audit application across the program.
• Write professional communications documenting quality review outcomes, audit findings, supporting rationale, error trends, and recommended next steps.
• Maintain quality review results and reporting to support performance monitoring, trend analysis, and leadership review.
• Communicate quality results, barriers, trends, and improvement recommendations to peers and management.
• Perform other duties as assigned.
• Conduct all job functions and responsibilities in accordance with all company Compliance, Information Security, HIPAA, regulatory policies, procedures, and programs.

Qualifications

• Registered Nurse, Associate's or Bachelor's degree required; active, unrestricted RN license in the United States required.
• 5+ years of acute care nursing, utilization review, clinical auditing, readmission review, quality review, or related healthcare experience preferred.
• Preference given to candidates with prior readmission, potentially preventable readmission, quality control, secondary review, peer review, audit validation, or clinical audit quality monitoring experience.
• Knowledge of potentially preventable readmission concepts, readmission drivers, discharge planning, transitions of care, and medical necessity preferred.
• Strong knowledge of inpatient medical record review, discharge planning, readmission drivers, medical necessity, transitions of care, and documentation requirements.
• Ability to synthesize complex inpatient medical record documentation, identify quality errors or missed opportunities, and make objective, evidence-based quality determinations.
• Demonstrates excellent written and verbal communication skills, strong analytical skills, attention to detail, and the ability to provide professional feedback.
• Proficient in Excel, Word, Outlook, OneNote, and general computer applications; able to work independently in a remote environment and deliver results during EXL core business hours.

Required Skills

• Clinical Readmission Review
• Quality Control Review
• Audit Sampling
• Medical Record Review
• Clinical Judgment
• Potentially Preventable Readmissions
• Root Cause Analysis
• Quality FeedbackCalibration
• Trend Identification
• Written Communication
• HIPAA Compliance

About EXLEXL is a global data analytics and digital operations and solutions company. We partner with clients using data, analytics, AI, and industry knowledge to improve business outcomes across healthcare and other industries.

The posted base salary range is the hiring base salary range for this role. Final offers are based on several factors, including: the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position.

EXL never requires fees, payments, or credit card or bank information during the recruitment or hiring process. A job offer is extended only after a formal interview process with Human Resources and the hiring team.