This position is fully remote.
This position requires a Registered Nurse or Licensed Clinical Social Worker, with current unrestricted license in appropriate state
The Clinical Quality Reviewer Ensures compliance with the contract, and program requirements for Clinical Quality Management (CQM) within TRICARE West Region. To ensure quality care is delivered for TRICARE beneficiaries by identifying, investigating, and evaluating medical records retrospectively for potential quality, safety, and utilization issues by using organizational, national, TRICARE, and URAC standards for consistency. Supports activities of peer review and quality and safety committees.
Required
Preferred
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
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