Clinical Quality Review Specialist

Job Description

Location: Remote

This is a full-time, fully remote position with no onsite or travel requirements.

We are seeking a Clinical Quality Review Specialist to support internal quality assurance efforts related to healthcare documentation and reimbursement review. This role focuses on reviewing completed clinical reviews and audit work to ensure accuracy, consistency, and alignment with established review standards.

The ideal candidate brings strong clinical knowledge, experience with documentation review or auditing, and a detail-oriented mindset suited for quality-focused, non-bedside work.

Key Responsibilities:

• Review completed clinical and reimbursement reviews to ensure accuracy, completeness, and adherence to internal quality standards.
• Evaluate supporting medical documentation to confirm review conclusions are appropriately substantiated.
• Identify trends, inconsistencies, or opportunities for improvement within review outcomes.
• Document quality findings and feedback clearly and professionally within internal systems.
• Support internal quality initiatives, including second-level reviews and peer feedback processes.
• Collaborate with clinical reviewers, quality teams, and leadership as needed.
• Maintain compliance with HIPAA and confidentiality requirements.
• Adhere to internal policies, procedures, and quality benchmarks.
• Perform additional duties to support quality assurance and operational objectives.

Qualifications:

• Active, unrestricted clinical license (RN or LVN) in the state of employment preferred.
• Minimum of two years of experience in clinical review, audit, quality assurance, or related non-bedside healthcare roles.
• Prior acute care clinical experience preferred but not required.
• Strong understanding of healthcare documentation and clinical review principles.
• Excellent analytical, organizational, and critical thinking skills.
• High attention to detail with the ability to identify inconsistencies and errors.
• Strong written and verbal communication skills.
• Proficiency with Microsoft Office tools, including Word and Excel.
• Ability to work independently in a fully remote environment while collaborating within a team structure.

Schedule & Work Environment:

• Full-time, fully remote position.
• Standard weekday schedule.
• Home-based work environment.

Salary Range:

The salary range for this position is $65,000 – $100,000 annually (approximately $31.25 – $48.08 per hour), based on experience.

Interview Process:

Selected candidates will participate in a multi-step interview process, which will include a screening call with TalentLNX, followed by virtual interviews with clinical and operational stakeholders.

Equal Opportunity Employer: TalentLNX is committed to equal employment opportunity and prohibits discrimination and harassment of any kind. We are dedicated to building a diverse workforce and fostering an inclusive work environment where all employees and candidates are treated with respect and dignity. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or any other protected status under applicable law. We actively seek to recruit, develop, and retain talented individuals from diverse backgrounds, and we encourage all qualified candidates to apply for our job opportunities.