Job Description

Remote Quality Management RN

Contract:

6-12 months (potential to convert to direct-hire)

Setting:

Not for profit health plan / managed care environment

Potential to turn into a direct-hire, permanent position

We're seeking an experienced

Remote Quality Management RN

to support quality-of-care investigations, adverse incident review, and HEDIS-related clinical audits. This role is ideal for a detail-driven nurse who enjoys clinical documentation review, provider collaboration, and improving member safety.

What You'll Do

Investigate and process Quality of Care (QOC) reviews and adverse incident cases Request, review, and summarize medical records to support clinical investigations Present case summaries to Physician Medical Reviewers and clinical leadership Document findings in internal tracking systems with accuracy and completeness Identify provider outliers, propose corrective action plans, and monitor compliance Track and evaluate trends in QOC issues to support reporting needs Conduct HEDIS chart audits, abstractions, and follow-up reviews Support contract compliance with state requirements and URAC standards Collaborate with Population Health, IT, and Quality teams on data and reporting needs Perform provider site visits as needed

What You Bring

Active RN license; BSN preferred 3-5 years clinical nursing experience 1+ years of hospital-based quality management/quality improvement experience is required Experience with QOC reviews, adverse incidents, CMS requirements, HEDIS, URAC, or health-plan quality work (preferred) Strong understanding of clinical documentation, case review, and quality criteria Proficiency in EHRs, data entry, Microsoft Excel, Word, and Outlook Exceptional attention to detail, organization, and communication Ability to escalate issues appropriately and manage multiple priorities

Why This Role Matters

You'll play a key part in ensuring members receive safe, high-quality care by reviewing clinical issues, supporting regulatory compliance, and promoting provider accountability. Your work directly strengthens the organization's quality program and improves outcomes for vulnerable populations.

Job Types: Full-time, Contract, Temporary

Pay: $45.00 - $47.00 per hour

Expected hours: 40 per week

Benefits:

401(k) Dental insurance Flexible spending account Health insurance Vision insurance
Application Question(s):

This is a contract position lasting between 6 and 12 months. There is potential for this to transition to direct-hire, permanent. Are you comfortable moving forward knowing this is a contract role?
Experience:

RN: 3 years (Required) hospital-based quality improvement: 1 year (Required)
Location:

Connecticut (Required)
Work Location: Remote