RN Clinical Quality Reviewer

Job Summary

RN Clinical Quality Reviewer

TEEMA

Full-time

Remote | Phoenix, AZ, United States

Overview:
We are partnering with a leading organization supporting a large-scale federal healthcare program to identify a Clinical Quality Reviewer. This role focuses on reviewing clinical cases, identifying potential quality or safety concerns, and supporting quality improvement initiatives across a complex healthcare delivery network. This is an excellent opportunity for a licensed clinical professional with experience in clinical review, utilization management, or healthcare quality within health plans, hospital systems, or government-supported programs.


What you will be doing:

• Review medical records to identify potential quality, safety, and utilization concerns

• Conduct detailed case analysis and prepare clear, well-documented 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 clinical leadership, including Medical Directors, to review findings

• Participate in quality committees and performance improvement efforts

• Ensure compliance with regulatory requirements and program standards

• Coordinate with cross-functional teams such as case management, care coordination, and program integrity

What you must have:

• Active, unrestricted license as a Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW)

• Minimum 3+ years of clinical experience (medical/surgical and/or behavioral health)

• U.S. Citizenship required

• Ability to obtain and maintain a Department of Defense (DoD) background clearance

• Strong analytical and critical thinking skills

• Excellent written communication skills

Nice to have:

• Bachelor’s degree in Nursing or healthcare-related field

• Experience in clinical quality, utilization review, or case review

• Familiarity with federal or government healthcare programs

• Experience with clinical criteria tools (InterQual or similar)

• Exposure to healthcare data analysis or reporting

Technical Skills

• Proficiency with Microsoft Office (Word, Excel, Outlook)

• Comfortable working across multiple systems and electronic medical records

What makes you successful

• Strong clinical judgment and attention to detail

• Ability to work independently and manage multiple priorities

• Analytical mindset with problem-solving ability

• Clear and professional communication skills

• Comfortable working in a structured, compliance-driven environment

Other Information:

• Remote or onsite depending on business needs

• Must have a secure home office setup if remote

• Occasional extended hours may be required