Remote Case Review & QA Manager

RediMinds, Inc; United States; Remote; USD 34,000 - 83,000; Part time

Job summary

RediMinds, Inc. is seeking a Case Review Manager for a fully remote, contract-to-hire role in the United States. You will oversee case files from intake through final determination, ensuring completeness, accuracy, and clear rationale for each decision.

Collaborating with clinicians and operations teams, you will validate summaries, correct gaps, and enforce confidentiality and professional standards while meeting regulatory deadlines.

Qualifications

• Hands-on experience in utilization review (UR), healthcare appeals, independent review, clinical review operations, or related QA.
• Ability to read and critically assess clinical documentation and identify omissions or inconsistencies.
• Excellent written communication and editing skills; able to make complex, sensitive determinations clear, accurate, and consistent.
• Exceptional attention to detail, sound judgment, and ability to manage multiple cases against firm deadlines.
• Comfort with technology-enabled systems and independently verifying outputs against source records.
• Understanding of patient confidentiality and impartial review processes.
• Bachelor’s degree in a healthcare-related field or equivalent experience.

Responsibilities

• Review case files for completeness and accuracy.
• Validate summaries against underlying records.
• Quality-check clinicians’ reviews for completeness and accuracy.
• Coordinate with clinicians to clarify gaps while preserving independence.
• Perform final QA on determination letters.
• Coordinate with clinical and operations teams to meet deadlines.
• Protect patient confidentiality and independence.

Skills

Utilization review

Clinical documentation review

Editing & writing

Attention to detail

Deadline management

Education

Bachelor's degree in healthcare or related field

Job description

RediMinds, Inc. is seeking a Case Review Manager for a fully remote, contract-to-hire role in the United States. You will oversee case files from intake through final determination, ensuring completeness, accuracy, and clear rationale for each decision.

Collaborating with clinicians and operations teams, you will validate summaries, correct gaps, and enforce confidentiality and professional standards while meeting regulatory deadlines.