Clinical Quality Reviewer - REMOTE - RN - US Citizen Required

Compensation: $85,000 – $92,000 Hourly Equivalent: \~$41–$44/hr Location: Remote Schedule: Must work AZ hours (typically 1st shift) ### **CLIENT NOTES / EXPECTATIONS** * Candidates must meet **required AND preferred qualifications** ### **APPROVED WORK STATES (RECRUITING GUIDELINES)** AK, AR, AZ, CO, DC, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NC, ND, NE, NM, NV, OK, OR, SC, SD, TN, TX, UT, VA, WA, WI, WY Only source candidates in these states ### **REQUIRED QUALIFICATIONS (MUST HAVE)** * Active, unrestricted license: + **RN** * Minimum 3\+ years clinical experience (med/surg and/or behavioral health) * Strong clinical documentation \+ writing ability * **U.S. Citizenship required** * **Must be eligible for DoD background clearance** ### **PREFERRED QUALIFICATIONS (HIGHLY DESIRED)** * Clinical Quality / Utilization Review / Case Review experience * Experience with federal or government healthcare programs * InterQual or similar clinical criteria tools * Data analysis / reporting exposure * Bachelor’s degree in Nursing or healthcare\-related field ### **CORE RESPONSIBILITIES (WHAT THEY ACTUALLY DO)** * Review medical records for quality, safety, and utilization issues * Identify Potential Quality Issues (PQIs) * Write detailed case summaries \+ recommendations * Support peer review \+ quality improvement initiatives * Collaborate with Medical Directors * Analyze trends and recommend improvements * Ensure compliance with regulatory and program standards ### **IDEAL CANDIDATE PROFILE** * Clinical reviewer / utilization review nurse * Experience with health plans or large healthcare systems * Experience in Med\-Surg in a hospital environment * Strong analytical \+ writing skills \#Workwolf