Remote RN Clinical Quality Reviewer

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

Job summary

TEEMA partners with a top healthcare organization to recruit a Clinical Quality Reviewer. You will review medical records for quality and utilization concerns, and prepare clear recommendations for quality improvement.

Remote or onsite options are available, with a secure home office if remote. The role requires an active RN or LCSW license, 3+ years of clinical experience in medical/surgical or behavioral health, and the ability to obtain a DoD background clearance.

Qualifications

• Active, unrestricted RN or LCSW license.
• Minimum 3+ years of clinical experience (medical/surgical and/or behavioral health).
• Ability to obtain and maintain a DoD background clearance.
• Strong analytical and critical thinking skills.
• Familiarity with InterQual or similar clinical criteria tools.
• Experience with healthcare data analysis or reporting.
• Experience with federal or government healthcare programs.

Responsibilities

• Review medical records to identify potential quality, safety, and utilization concerns.
• Conduct detailed case analysis and prepare summaries and recommendations.
• Support peer review processes and quality improvement initiatives.
• Analyze trends and assist in identifying patterns in care delivery and outcomes.
• Collaborate with Medical Directors to review findings.
• Participate in quality committees and performance improvement efforts.
• Ensure compliance with regulatory requirements and program standards.
• Coordinate with case management, care coordination, and program integrity.

Skills

Clinical review

Utilization mgmt

Healthcare quality

Data analysis

Regulatory compliance

InterQual

EMR proficiency

MS Office

Education

RN or LCSW license

Tools

EMR systems

MS Office

Job description

TEEMA partners with a top healthcare organization to recruit a Clinical Quality Reviewer. You will review medical records for quality and utilization concerns, and prepare clear recommendations for quality improvement.

Remote or onsite options are available, with a secure home office if remote. The role requires an active RN or LCSW license, 3+ years of clinical experience in medical/surgical or behavioral health, and the ability to obtain a DoD background clearance.