Quality of Care and Clinical Review Nurse
Health Care Service Corporation · United States · US
Quality Improvement
Remote
physician
Nurse
Demand78
Career growth72
Healthcare fit86
Remote potential55
Salary band
USD 70k – 126k
5-year outlook
Stable payer-side quality and clinical review role with likely progression into quality-of-care management, regulatory quality, or patient safety leadership. Exact compensation is not stated; outlook depends on payer market and RN quality-review experience.
Clinical license
Required
Applicant reach
moderate
Seniority
mid
Employment type
full-time
Date found
2026-10-24
Intelligence details
Flexible work details
- Engagement type
- Permanent
- Hours
- Full-time
- Eligible countries
- United States
- License jurisdiction
- US
- Profession fit
- physician, Nurse
- Rate period
- Annual
Listing via Himalayas.
Eligibility, licensing, and location restrictions can change. Always confirm details on the source posting before applying.
Why this is worth applying to
Worth considering for RNs with managed care, quality, appeals/grievances, risk, or patient safety experience who want a non-bedside payer role. Less suitable for early-career nurses or clinicians without RN licensure and managed care exposure.
Who should apply
RNs with 5+ years of healthcare experience, especially those with managed care, quality improvement, patient safety, risk management, appeals/grievances, regulatory compliance, or clinical chart review backgrounds.
CV angle
Frame real RN experience around clinical review, medical record evaluation, patient safety, quality improvement, regulatory compliance, root cause analysis, provider communication, and trend reporting. Emphasize managed care exposure, NCQA/CMS familiarity, and examples of investigating or resolving care-quality concerns without inventing quality-specific experience.
Skills to highlight
- Clinical review
- Medical record review
- Quality improvement
- NCQA/CMS regulatory knowledge
- Managed care processes
- Root cause analysis
- Patient safety and risk management
- Stakeholder communication and presentation
Role summary
A payer-based RN quality role that reviews and investigates potential quality-of-care issues, supports quality management activities, and ensures compliance with CMS, state, and NCQA requirements.
We publish our own intelligence summary, never the full job description. Always confirm details with the employer when you apply.