Quality Review Specialist | Remote | Contract to Hire

Quality Review Specialist | 5+ Years of Experience | Remote | Contract

Walker Healthforce is seeking a Quality Review Specialist with 5+ years of healthcare utilization management and appeals experience to support member and provider appeal operations while ensuring compliance with accreditation and regulatory standards. This is a Contract opportunity.

Start Date: ASAP

Location: Remote (Applicants may reside anywhere in the U.S. except NY, CA, and AK)

Hours/Schedule: Monday-Friday, 40 hours

Worker Type: W2

Core Requirements:

• Active RN or LPN/LVN license in good standing
• 5+ years of utilization management, appeals, claims, and mainframe systems experience
• Bachelor's Degree or equivalent healthcare experience
• Knowledge of managed care processes
• Experience with NCQA and URAC accreditation standards
• Strong communication and organizational skills
• Microsoft Word, Access, and Excel proficiency

We Consider It A Bonus If You Also Have:

• Appeals experience
• Utilization Management experience

Job Responsibilities:

• Coordinate member and provider appeals.
• Manage appeal inventory and workflow.
• Collaborate with Utilization Management, Case Management, and Customer Service teams.
• Support audit and accreditation activities.
• Ensure compliance with regulatory and accreditation requirements.
• Prepare reports and maintain documentation.
• Assist with departmental initiatives and special projects.

What We Offer:

• Competitive compensation package
• Weekly pay via Direct Deposit
• Medical, Dental & Vision available
• 401k options

Why Work With Walker?

• Access to our top ranked team of recruiting and placement specialists
• Continuous, one-on-one support from a dedicated engagement manager
• Professional resume development and interview preparation

Contact our Recruiting Team today to experience the Walker Healthforce difference!

About Us:

Walker Healthforce is known as the dominant force of performance, precision, expertise, and integrity in the healthcare consulting community! As a certified WMBE, we provide end-to-end healthcare IT and clinical solutions to hospitals, health systems, and payer organizations, including Fortune 100 firms nationwide. We are healthcare experts, we're custom not commodity and we've been exceeding expectations for nearly 20 years. Join forces with us to experience unparalleled results today!

We are an Equal Opportunity Employer committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment.