RN Clinical Quality Reviewer Remote

RN Clinical Quality Reviewer - Remote

TEEMA GROUP - 4.0

Tucson, AZ Job Details Full-time $85,000 - $92,000 a year 12 hours ago Qualifications Direct patient care RN License Full Job Description Immediate Hiring Need - Remote RN Opportunity We are seeking experienced Registered Nurses with a strong background in Clinical Quality, Utilization Review, Case Management, or Chart Auditing for a fully remote Clinical Quality Reviewer opportunity. This is an excellent opportunity for RNs with managed care, health plan, inpatient review, or quality improvement experience who enjoy analytical work, clinical documentation review, and improving patient care outcomes. What You'll Do Review medical records for quality, compliance, and medical necessity Conduct chart audits and documentation reviews Identify potential quality issues and recommend improvements Write detailed clinical summaries and recommendations Apply InterQual and evidence-based criteria Collaborate with Medical Directors, case managers, and interdisciplinary teams Support quality improvement and peer review initiatives Ensure compliance with regulatory and healthcare program standards What We're Looking For ✔ Active RN license ✔ 3+ years of clinical nursing experience ✔ Strong utilization review, quality review, or case management background ✔ Experience reviewing medical records and clinical documentation ✔ InterQual experience strongly preferred ✔ Inpatient Med-Surg or acute care experience preferred ✔ Excellent analytical and written communication skills ✔ Experience with managed care, health plans, or government healthcare programs is a plus Ideal Candidate Backgrounds Clinical Quality RN Utilization Review RN Case Management RN Managed Care RN Clinical Documentation Review RN Concurrent Review Nurse Appeals & Grievances RN Quality Improvement RN Preferred Experience

HEDIS / NCQA

Medicare / Medicaid Appeals & denials Regulatory compliance Care coordination Audit readiness Data analysis and reporting If you are an experienced RN looking to transition into a high-impact remote clinical quality role, we encourage you to apply today. Email your resume today! #Workwolf