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Quality Review Nurse Remote Jobs (NOW HIRING)

TEEMA Group

Clinical Quality Review Nurse

Phoenix, AZ · Remote

$41 - $44/hr

USA- Remote in approved states Overview: TEEMA is partnering with a leading organization supporting a large-scale federal healthcare program to identify a Clinical Quality Reviewer. This role focuses ...

TEEMA Group

REMOTE RN - Quality Review

Phoenix, AZ · Remote

$42 - $43.50/hr

... in Nursing or healthcare-related field * Experience in clinical quality, utilization review, or ... Remote or onsite depending on business needs * Must have a secure home office setup if remote

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... Our collaborative approach ensures members receive high-quality, personalized care while supporting ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... Our collaborative approach ensures members receive high-quality, personalized care while supporting ...

Astrana Health, Inc.

UM Review Nurse

Monterey Park, CA · On-site +1

$34 - $47/hr

UM Review Nurse Department: HS - UM Employment Type: Full Time Location: 1600 Corporate Center Dr ... This is a remote position for CA-licensed nurses. Candidates must live in California. We are ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson ... quality of medical/surgical services, and serving as liaison between providers and medical and ...

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All JobsQuality Review Nurse JobsQuality Review Nurse Remote Jobs

Quality Review Nurse Remote information

See salary details

$29.5K

$90.3K

$170K

How much do quality review nurse remote jobs pay per year?

As of Jul 29, 2026, the average yearly pay for quality review nurse remote in the United States is $90,275.00, according to ZipRecruiter salary data. Most workers in this role earn between $66,500.00 and $102,500.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Quality Review Nurse Remote, and why are they important?

To thrive as a Quality Review Nurse Remote, you need a nursing degree (RN), active RN license, and strong clinical review and analytical skills. Familiarity with utilization management systems, electronic health records (EHRs), and quality assurance software is typically required. Attention to detail, effective communication, and self-motivation are essential soft skills for excelling in a remote environment. These skills ensure accurate quality assessments, regulatory compliance, and effective collaboration while working independently.

What is the difference between Quality Review Nurse Remote vs Utilization Review Nurse Remote?

AspectQuality Review Nurse RemoteUtilization Review Nurse Remote
CertificationsRN license, possibly CCRN or CPHQRN license, often with UR or CCM certification
Work EnvironmentRemote, healthcare settings, insurance companiesRemote, insurance companies, healthcare organizations
Job FocusAssess quality of care, compliance, patient safetyEvaluate medical necessity, approve or deny services

Both roles are remote nursing positions within healthcare and insurance industries. Quality Review Nurses focus on assessing care quality and compliance, while Utilization Review Nurses primarily evaluate medical necessity for services. While they share certifications and work environments, their core responsibilities differ, making each role unique in healthcare quality and utilization management.

What does a Quality Review Nurse do in a remote position?

A Quality Review Nurse working remotely is responsible for reviewing medical records, ensuring compliance with healthcare regulations, and evaluating the quality of patient care provided by healthcare facilities. They analyze documentation to verify accuracy, completeness, and adherence to clinical guidelines. By working remotely, they use secure digital systems to access records, communicate with healthcare teams, and contribute to quality improvement initiatives from a home or off-site location.

What are some common challenges faced by Quality Review Nurses working remotely, and how can they be managed?

Quality Review Nurses working remotely often encounter challenges such as staying updated with rapidly changing healthcare regulations, maintaining effective communication with healthcare teams, and managing time efficiently while handling multiple case reviews. To address these challenges, it's helpful to establish a structured daily routine, leverage collaboration tools for regular check-ins with colleagues, and participate in ongoing training or webinars to stay current on policies. Proactive communication and strong organizational skills are key to excelling in this remote role.
More about Quality Review Nurse Remote jobs
What cities are hiring for Quality Review Nurse Remote jobs? Cities with the most Quality Review Nurse Remote job openings:
What are the most commonly searched types of Quality Review Nurse jobs? The most popular types of Quality Review Nurse jobs are:
What states have the most Quality Review Nurse Remote jobs? States with the most job openings for Quality Review Nurse Remote jobs include:
What job categories do people searching Quality Review Nurse Remote jobs look for? The top searched job categories for Quality Review Nurse Remote jobs are:
Quality Review Nurse Remote jobs near you
Infographic showing various Quality Review Nurse Remote job openings in the United States as of July 2026, with employment types broken down into 3% As Needed, 57% Full Time, 15% Part Time, and 25% Contract. Highlights an 99% Physical, and 1% Remote job distribution, with an average salary of $90,275 per year, or $43.4 per hour.

Clinical Review Nurse - Remote

ARC Group

Jacksonville, FL • Remote

Full-time

Re-posted 15 days ago

Job description

CLINICAL REVIEW NURSE - REMOTE
ARC Group has multiple positions open for Clinical Review Nurses! These positions are 100% remote. These are direct hire FTE positions with salary, benefits, etc. This is a fantastic opportunity to join a dynamic and well-respected organization offering tremendous career growth potential.
At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply.
100% REMOTE!
Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3rd party / brokering).
SUMMARY STATEMENT
The Clinical Review Nurse is responsible for reviewing and making medical determinations as to the validity of health claims and levels of payment in meeting national and local policies as well as accepted medical standards of care. The incumbent applies clinical knowledge to assess the medical necessity, level of services and appropriateness of care which may include cases requiring prior authorization, complex pre-payment medical review or post-payment medical review.
ESSENTIAL DUTIES & RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.
90% of time will be spent on one or more of the following activities depending on assignments:
Review and analyze pre and post pay complex health care claims from a medical perspective, inclusive of prior authorization:
  • Perform clinical review work as assigned; may provide guidance to other team members and accurately interpret and apply broad CMS guidelines to specific and highly variable situations.
  • Conduct review of claim data and medical records to make clinical decisions on the coverage, medical necessity, utilization and appropriateness of care per national and local policies, as well as accepted medical standards of care.
  • Review provider practices and identify issues of concern, overpayment and need for corrective action as necessary; includes surfacing potential fraud and abuse or practice concerns.
  • May develop recommendations for further corrective action based on medical review findings.
  • May refer for review, or implement, corrective action related to medical review activities.
  • May process claims and complete project work in the appropriate computer system(s).

The remaining 10% of time will be spent on the following activities depending on assignments:
Identify providers needing education and individually educate providers who are subject to medical
review processes:
  • Initiate or participate in provider teaching activities, creating written teaching material, providing one on one education or education to a group as a result of a medical review (e.g., probe, progressive corrective action, consent, etc.) or appeal.
  • This may involve discussion with CMS leaders and leaders in the provider community.
  • Participate in special projects as assigned.

REQUIRED QUALIFICATIONS
* Valid nursing degree
* 2 years' clinical experience
* Excellent written and oral communication skills
* Demonstrated experience with evaluating medical and health care delivery issues (e.g., Inpatient Rehab Facility)
* Strong computer skills to include Microsoft Office proficiency
* Valid unrestricted Registered Nurse (RN) license
PREFERRED QUALIFICATIONS
* Inpatient Rehabilitation Facility Experience
* Bachelor of Science in Nursing (BSN)
* Insurance industry experience
* Certified Coder
ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed.
At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know.
Position is offered with no fee to candidate.