Remote Utilization Review Rn Jobs in Maryland (NOW HIRING)

Registered Nurse, Quality Assurance — In-Home Clinical Services 

The candidate must reside in the Greater Baltimore area and be willing to travel throughout the state of MD.

Position Summary 

The Registered Nurse, Quality Assurance is responsible for driving the clinical quality and consistency of practitioners who perform in-home assessments, laboratory tests, and diagnostic services across the member's home or any alternate location where services are delivered. This role combines clinical oversight, data-driven performance analysis, and direct coaching to ensure every encounter meets evidence-based standards, regulatory requirements, and the organization's quality benchmarks. The RN Quality Assurance partner serves as both an auditor and an educator — translating quality data into actionable feedback that elevates practitioner performance and improves member outcomes. 

Key Responsibilities 

Quality Oversight & Auditing 

• Conduct routine and targeted audits of in-home assessments, lab specimen collection, and diagnostic procedures performed by field practitioners (NPs, RNs and LPNs 

• Review documentation, chart notes, and encounter data for completeness, clinical accuracy, and adherence to protocols. 

• Perform ride-along and virtual observation visits to assess clinical technique, member interaction, infection control, and specimen handling. 

• Identify deviations from clinical standards and document findings in the quality management system. 

Data Analysis & Reporting 

• Analyze quality metrics, audit results, lab rejection rates, redraw rates, and member-experience data to identify trends and root causes. 

• Build and maintain dashboards and reports that surface practitioner-level and program-level performance to operations and clinical leadership. 

• Translate quantitative findings into prioritized improvement opportunities with measurable targets. 

• Partner with data and analytics teams to refine quality measures and benchmarks over time. 

Coaching, Education & Practitioner Development 

• Deliver one-on-one feedback and coaching to practitioners based on audit findings, with clear expectations and follow-up. 

• Design and assist in training sessions, in-services, and competency assessments covering clinical procedures, documentation, and member experience. 

• Develop job aids, SOPs, and reference materials that codify best practices for in-home and alternate-site service delivery. 

• Mentor new hires through onboarding and validate clinical competency before independent practice. 

Compliance & Continuous Improvement 

• Ensure practitioner activities comply with CLIA, OSHA, HIPAA, state nursing scope-of-practice rules. 

• Investigate clinical incidents, near misses, and member complaints; document findings and recommend corrective action. 

• Collaborate with Operations to close gaps and operationalize new clinical workflows. 

Required Qualifications 

• Active, unrestricted Registered Nurse (RN) license in the state of residence; willingness to obtain additional state licensure or compact privileges as required. 

• Bachelor of Science in Nursing (BSN) required; advanced degree (MSN, MPH, or MHA) preferred. 

• Minimum 5 years of clinical nursing experience, with at least 2 years in quality assurance, clinical auditing, case management, or a comparable oversight role. 

• Experience with in-home care, mobile health, home health, or community-based clinical services strongly preferred. 

• Working knowledge of laboratory specimen collection, point-of-care testing, and common in-home diagnostic procedures. 

• Familiarity with CLIA, OSHA, HIPAA, and applicable state and federal regulations governing clinical practice. 

Skills & Competencies 

• Analytical mindset — comfortable working with audit data, performance metrics, and Excel or Tableau tools to identify patterns and prioritize action. 

• Strong written and verbal communication skills, with the ability to deliver direct, constructive feedback to clinicians at all levels. 

• Sound clinical judgment and meticulous attention to detail in reviewing documentation and observing procedures. 

• Coaching and adult-learning skills; able to teach without alienating. 

• Proficiency with electronic health records, quality management platforms, and Microsoft Office (Excel, Word, PowerPoint). 

• Ability to work independently, manage a multi-state caseload, and prioritize across competing audits and projects. 

Working Conditions 

• Hybrid role with a mix of remote chart review, virtual coaching, and field-based observation visits. 

• Travel up to 50–60% (or as determined by the business) to member homes, partner sites, or other service locations for ride-alongs and audits. 

• Occasional evening or weekend availability to observe practitioners working non-standard shifts. 

• Must maintain a valid driver's license, reliable transportation, and current auto insurance.