Remote Utilization Management RN – QA & Compliance

TEKsystems; United States; Remote; USD 37,000 - 39,000; Full time

Benefits offered by this job

Medical, dental & vision

401(k) retirement plan

Life Insurance

Short/long-term disability

HSA

Transportation benefits

Employee Assistance Program

PTO/Vacation

Job summary

TEKsystems is seeking a Clinical Quality Assurance Coordinator for a fully remote, contract-to-hire position. You will ensure high-quality case reports comply with client agreements and regulatory standards, handling QA queries and supporting the QA department.

Requirements include active RN licensure, utilization management experience, and 2–4 years of relevant work. The role emphasizes adherence to ERISA/state mandates and rigorous documentation across reviews.

Qualifications

• MUST HAVE Utilization Management experience.
• MUST BE a Registered Nurse.
• Need at least 2-4 years experience.

Responsibilities

• Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.
• Ensure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
• Ensure that all client instructions and specifications have been followed and that all questions have been addressed.
• Ensure each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.
• Ensure the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
• Ensure the appropriate board specialty has reviewed the case in compliance with client specifications or state mandates and is documented accurately on the case report.
• Assist in resolution of client complaints and quality assurance issues as needed.
• Ensure all federal ERISA and state mandates are adhered to at all times.

Skills

Utilization Management

Registered Nurse

2-4 years experience

Job description

TEKsystems is seeking a Clinical Quality Assurance Coordinator for a fully remote, contract-to-hire position. You will ensure high-quality case reports comply with client agreements and regulatory standards, handling QA queries and supporting the QA department.

Requirements include active RN licensure, utilization management experience, and 2–4 years of relevant work. The role emphasizes adherence to ERISA/state mandates and rigorous documentation across reviews.