REMOTE RN - Quality Review

Overview:

TEEMA is 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)

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

Strong analytical and critical thinking 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

Salary/Rate Range:

$85,000 – $92,000 annually; Hourly Equivalent: Approximately $41 – $44/hour