Clinical Readmission Review Quality Analyst

EXL • United States,

4h • $60,100 - $98,700 • Remote

About The Position

The Clinical Readmission Review Quality Analyst oversees work performed by Clinical Readmission Review Auditors to ensure EXL’s standard of accuracy, consistency, and documentation quality is met. The analyst performs quality reviews of random and targeted samples of completed readmission audits and applies expert clinical knowledge when reviewing inpatient medical records to confirm that audit determinations are clinically supported, appropriately documented, aligned with program requirements, and supported by clear rationale. This role identifies quality trends, provides feedback and coaching support to auditors, supports calibration, and recommends process improvements to strengthen overall audit quality and performance.

Requirements

• Registered Nurse, Associate’s or Bachelor’s degree required; active, unrestricted RN license in the United States required.
• 5+ years of acute care nursing, utilization review, clinical auditing, readmission review, quality review, or related healthcare experience preferred.
• Preference given to candidates with prior readmission, potentially preventable readmission, quality control, secondary review, peer review, audit validation, or clinical audit quality monitoring experience.
• Knowledge of potentially preventable readmission concepts, readmission drivers, discharge planning, transitions of care, and medical necessity preferred.
• 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.
• Demonstrates excellent written and verbal communication skills, strong analytical skills, attention to detail, and the ability to provide professional feedback.
• Proficient in Excel, Word, Outlook, OneNote, and general computer applications; able to work independently in a remote environment and deliver results during EXL core business hours.

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 Clinical Readmission Review 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 Clinical Readmission Review Auditors based on quality review outcomes, including clear coaching points and examples when needed.
• Utilize extensive 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 across the program.
• 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.
• Conduct all job functions and responsibilities in accordance with all company Compliance, Information Security, HIPAA, regulatory policies, procedures, and programs.

Benefits

• Salary Range: $60,100 - $98,700
• 100% Remote, U.S.-based
• Travel: Up to 10% annually

What This Job Offers

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