Job Description

Clinical Quality Management Analyst (RN/LPN) – Remote (Pennsylvania)

Location: 100% Remote – Must reside in Pennsylvania
Job Type: Contract (Potential for Extension)
Contract Duration: December 7, 2026 – March 6, 2027
Job Reference ID: 22692-1
Citizenship Requirement: U.S. Citizens Only

Position Overview

We are seeking a detail-oriented Clinical Quality Management Analyst (RN or LPN) to support healthcare quality initiatives for a leading healthcare organization within its WholeCare division. This fully remote opportunity is ideal for a licensed nursing professional with strong medical record review experience, HEDIS knowledge, and a passion for improving healthcare quality and compliance.

The Clinical Quality Management Analyst will be responsible for reviewing and analyzing medical records, identifying opportunities for quality improvement, ensuring accurate clinical documentation, and supporting compliance with healthcare quality standards.

The ideal candidate will have 3–5 years of medical record review experience, hands-on HEDIS experience, strong technical skills, and exceptional attention to detail.

Key Responsibilities

• Conduct comprehensive medical record reviews to evaluate clinical documentation, quality of care, and compliance with established standards.

• Review, extract, and analyze clinical information from medical records to support HEDIS and quality improvement initiatives.

• Identify gaps, discrepancies, and opportunities for improvement in medical documentation and coding accuracy.

• Support appropriate ICD-10-CM coding through accurate documentation review and analysis.

• Collaborate with internal departments to support compliance, process improvement, and quality management initiatives.

• Assist in identifying and implementing process improvements that enhance healthcare quality and member outcomes.

• Utilize Microsoft Excel and other healthcare technology systems to organize, analyze, and track medical record information.

• Maintain accurate records and ensure data integrity throughout the medical review process.

• Communicate professionally with internal teams, healthcare providers, and other stakeholders to resolve documentation issues.

• Support initiatives focused on improving member and provider satisfaction.

• Ensure timely completion of medical record reviews while maintaining high standards of accuracy and quality.

Required Qualifications

• Active RN or LPN license in Pennsylvania – Required

• 3–5 years of medical record review experience – Required

• HEDIS experience – Required

• Strong background in reviewing, interpreting, and analyzing clinical medical records.

• Previous customer service experience with excellent communication and interpersonal skills.

• Proficiency in Microsoft Excel, including organizing, tracking, and managing data.

• Strong technical aptitude and ability to navigate electronic medical records (EMR/EHR) and multiple computer systems.

• Exceptional attention to detail, accuracy, and organizational skills.

• Ability to work independently and manage deadlines in a fully remote environment.

• Strong analytical and problem-solving abilities.

• Must reside in Pennsylvania.

• Must be a U.S. Citizen.

Preferred Qualifications

• Previous experience in healthcare quality improvement initiatives.

• Familiarity with ICD-10-CM coding and clinical documentation standards.

• Experience supporting healthcare compliance and quality management programs.

• Experience working within a health insurance organization, managed care environment, or Medicaid health plan.

Additional Position Details

• Work Arrangement: 100% Remote (Pennsylvania residents only)

• Contract Length: Approximately 3 months, with potential extensions based on business needs.

• Schedule: Remote work schedule.

• Assessment: Candidates must complete the Clinical Quality Management Analyst Assessment as part of the selection process.

Why Consider This Opportunity?

This position offers the opportunity to utilize your nursing background and clinical expertise in a fully remote, non-bedside role focused on healthcare quality and medical record review. You will contribute to meaningful quality improvement initiatives while collaborating with healthcare professionals to support better patient outcomes.

Apply today if you are a Pennsylvania-licensed RN or LPN with HEDIS and medical record review experience looking for a fully remote opportunity!