Job Description

Utilization Review Nurse - Quality Investigations $31.13/hr | 6-Month Contract-to-Hire | 10 Remote Positions Available Remote (Must Reside in an EST State + Hold Compact RN License) Schedule: Monday-Friday, 8:00 AM-5:00 PM Eastern Time (ET) Flexibility: Occasional work outside standard hours may be required Location: 100% Remote (must reside in EST time zone and have an active compact state license) About the Role: Join our dynamic Potential Quality of Care (PQOC) team as a Utilization Review Nurse - Quality Investigations. In this fully remote RN role, you’ll review clinical documentation to assess potential quality of care issues, patient safety events, and ensure compliance with health plan policies and regulations across Medicare, Medicaid, and Commercial lines of business. This position is perfect for experienced nurses who enjoy critical thinking, clinical analysis, and meaningful work that impacts patient safety — all from the comfort of home. Key Responsibilities: Evaluate clinical documentation for Potential Quality of Care (PQOC) cases and Patient Safety Events. Review and interpret medical records using multiple internal systems. Apply clinical guidelines, regulatory requirements, and benefit policies to case reviews. Communicate with providers, vendors, and internal teams to gather necessary documentation. Condense findings into clear clinical summaries for resolution and reporting. Use critical thinking and team decision rubrics to support appropriate case outcomes. Collaborate with internal clinical teams to ensure compliance and quality standards. Required Qualifications: Active, unrestricted Compact RN license ADN or BSN required Must reside in an Eastern Time Zone (EST)- States include: Connecticut, Florida, Georgia, Indiana (parts), Kentucky (parts), Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Virginia, Washington D.C. 3+ years of direct clinical RN experience Proficiency in navigating multiple computer systems and using Microsoft Office Suite (Teams, Outlook, Excel, Word) Background in Emergency Room, ICU, or critical care nursing Experience with grievance case reviews, utilization management, or case management Previous managed care or insurance-based nursing experience Benefits (Available After 90 Days): Medical, dental, and vision insurance Life insurance and short-term disability 401(k) with company match after 1 year of service Apply Now Be part of a growing team where your clinical insight contributes directly to improving patient outcomes. 10 remote RN roles are available —don't miss your chance to make a meaningful impact while enjoying work-life balance. Contact: Alliston Brown | 586-710-7944 | alliston@alinestaffing.com A-Line Staffing Solutions

Job Tags

Contract work, Temporary work, Casual work, Work at office, Monday to Friday,

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