Clinical Readmission Review Quality Analyst

EXL • United States,

10d • $60,100 - $98,700 • Remote

About The Position

The Clinical Readmission Review Quality Analyst oversees the quality of work performed by Clinical Readmission Review Auditors. The role reviews random and targeted samples of completed audits, applying expert clinical knowledge to confirm that audit determinations are clinically supported, appropriately documented, aligned with program requirements, and supported by clear rationale. The analyst identifies quality trends, provides feedback and coaching support, participates in calibration, and recommends improvements to strengthen audit quality and performance.

This is a 100% remote, U.S.-based position with travel of up to 10% annually. A quality review, clinical audit, or written documentation assessment may be part of the interview process. The position requires an active, unrestricted U.S. RN license and a Registered Nurse, Associate’s, or Bachelor’s degree. The analyst must be able to work independently in a remote environment and deliver results during EXL core business hours.

Requirements

• Registered Nurse, Associate’s, or Bachelor’s degree required.
• Active, unrestricted RN license in the United States required.
• Strong knowledge of inpatient medical record review, discharge planning, readmission drivers, medical necessity, transitions of care, and documentation requirements.
• Ability to synthesize complex inpatient medical record documentation, identify quality errors or missed opportunities, and make objective, evidence-based quality determinations.
• Excellent written and verbal communication skills, strong analytical skills, attention to detail, and ability to provide professional feedback.
• Proficiency in Excel, Word, Outlook, OneNote, and general computer applications.
• Ability to work independently in a remote environment and deliver results during EXL core business hours.
• Compliance with HIPAA requirements.

Nice To Haves

• Five or more years of acute care nursing, utilization review, clinical auditing, readmission review, quality review, or related healthcare experience.
• Prior experience in readmission, potentially preventable readmission, quality control, secondary review, peer review, audit validation, or clinical audit quality monitoring.
• Knowledge of potentially preventable readmission concepts, readmission drivers, discharge planning, transitions of care, and medical necessity.

Responsibilities

• Apply clinical judgment and readmission review knowledge to ensure the accuracy and consistency of completed Clinical Readmission Review audits.
• Perform quality reviews of random and targeted samples of auditor work to validate findings, no-findings, clinical rationale, and supporting documentation.
• Follow approved sampling methodology for random, targeted, and follow-up quality reviews.
• Apply established quality scoring criteria to evaluate audit accuracy, documentation quality, and adherence to program expectations.
• Confirm that readmission determinations are supported by the medical record, applicable clinical criteria, client requirements, and internal procedures.
• Review audit documentation for clarity, completeness, grammar, evidence-based support, and alignment with EXL quality expectations.
• Provide feedback and coaching support to auditors based on quality review outcomes, including clear coaching points and examples when needed.
• Use clinical and industry knowledge to identify audit trends, missed opportunities, recurring errors, and potential referrals for additional review or escalation.
• Provide root cause analysis on quality errors and recommend corrective actions to improve audit accuracy, documentation quality, and performance.
• Support calibration discussions, quality monitoring, standard operating procedure updates, and training opportunities to promote consistent audit application.
• Write professional communications documenting quality review outcomes, audit findings, supporting rationale, error trends, and recommended next steps.
• Maintain quality review results and reporting to support performance monitoring, trend analysis, and leadership review.
• Communicate quality results, barriers, trends, and improvement recommendations to peers and management.
• Perform other duties as assigned.
• Perform job functions in accordance with company compliance, information security, HIPAA, regulatory policies, procedures, and programs.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree