Clinical Readmission Review Quality Analyst

EXL • United States,

12h • $60,100 - $98,700 • Remote

About The Position

The Clinical Readmission Review Quality Analyst oversees work performed by Clinical Readmission Review Auditors to ensure accuracy, consistency, and documentation quality. The analyst reviews random and targeted samples of completed readmission audits, applying clinical expertise to verify that determinations are clinically supported, appropriately documented, aligned with program requirements, and supported by clear rationale.

The role identifies quality trends, provides auditor feedback and coaching support, contributes to calibration, and recommends process improvements to strengthen audit quality and performance. It is 100% remote and U.S.-based, with travel up to 10% annually. A quality review, clinical audit, or written documentation assessment may be part of the interview process. The posted base salary range is $60,100–$98,700.

Requirements

• Registered Nurse with an associate’s or bachelor’s degree.
• Active, unrestricted RN license in the United States.
• 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 and applicable regulatory, company, and program 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 with 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 audits.
• Perform quality reviews of random and targeted samples of auditor work, validating 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 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 quality expectations.
• Provide feedback and coaching support to auditors based on quality review outcomes, including coaching points and examples as needed.
• Use clinical and industry knowledge to identify audit trends, missed opportunities, recurring errors, and potential referrals for further review or escalation.
• Conduct root cause analysis of 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.
• Write professional communications documenting quality review outcomes, audit findings, supporting rationale, error trends, and recommended next steps.
• Maintain quality review results and reporting for 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 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