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:RNMinimum 3+ years clinical experience (med/surg and/or behavioral health)Strong clinical documentation + writing abilityU.S. Citizenship requiredMust be eligible for DoD background clearance Preferred Qualifications (highly Desired) Clinical Quality / Utilization Review / Case Review experienceExperience with federal or government healthcare programsInterQual or similar clinical criteria toolsData analysis / reporting exposureBachelor’s degree in Nursing or healthcare-related field Core Responsibilities (what They Actually Do) Review medical records for quality, safety, and utilization issuesIdentify Potential Quality Issues (PQIs)Write detailed case summaries + recommendationsSupport peer review + quality improvement initiativesCollaborate with Medical DirectorsAnalyze trends and recommend improvementsEnsure compliance with regulatory and program standards IDEAL CANDIDATE PROFILE Clinical reviewer / utilization review nurseExperience with health plans or large healthcare systemsExperience in Med-Surg in a hospital environmentStrong analytical + writing skills