Remote Registered Nurse — Quality & Compliance Reviewer

Staffmark Group; Atlanta (GA); Remote; USD 33,000 - 43,000; Full time

Benefits offered by this job

Weekly pay

Medical, dental, and vision coverage

Life and Disability Insurance

401(k) Plan

Growth opportunities

Job summary

Staffmark Group is recruiting a Registered Nurse for a remote role. Primary duties include reviewing peer review reports, ensuring evidence-based rationales, and ensuring compliance with client, contract, and regulatory standards.

The ideal candidate holds an RN or LPN license, high school diploma or equivalent, proficient computer skills, and can manage multiple priorities while communicating clearly. Competitive weekly pay and comprehensive benefits are offered.

Qualifications

• Valid RN or LPN license.
• High school diploma or equivalent required.
• Strong knowledge of medical terminology, anatomy and physiology, medications, and lab values.
• Understanding of HIPAA regulations and healthcare compliance standards.
• Proficient in MS Word, Outlook, Excel; 40 WPM typing speed.
• Experience reviewing clinical documentation or QA processes preferred.
• Strong written and verbal communication; ability to manage multiple priorities.

Responsibilities

• Review peer review reports, correspondence, addendums, and supplemental reviews for quality and accuracy.
• Verify reports contain clear, evidence-based rationales supporting recommendations and determinations.
• Ensure client instructions, contractual requirements, and regulatory standards are followed.
• Confirm all required questions have been addressed and documented appropriately.
• Review clinical citations and references for accuracy, relevance, and currency.
• Ensure reports meet company standards for content, format, and professional appearance.
• Verify appropriate physician specialty reviews completed according to client and state requirements.
• Confirm reviewer attestations, credentials, signatures, and conflict-of-interest compliance.
• Communicate with peer reviewers to resolve inconsistencies, corrections, or clarification requests.
• Assist with client complaints, QA concerns, and compliance-related issues.
• Ensure adherence to ERISA regulations, state mandates, and company policies.
• Provide feedback to management regarding consultant quality, availability, and compliance.
• Support continuous QA initiatives and efficient use of company resources.
• Participate in required training, education, and professional development activities.

Skills

RN/LPN license

HIPAA compliance

Medical terminology

Typing 40 WPM

Strong communication

Independent worker

Education

High school diploma or equivalent

Tools

Microsoft Word

Outlook

Excel

Job description

Staffmark Group is recruiting a Registered Nurse for a remote role. Primary duties include reviewing peer review reports, ensuring evidence-based rationales, and ensuring compliance with client, contract, and regulatory standards.

The ideal candidate holds an RN or LPN license, high school diploma or equivalent, proficient computer skills, and can manage multiple priorities while communicating clearly. Competitive weekly pay and comprehensive benefits are offered.