Nurse - SIU Experience REQUIRED 100% Remote

We’re TEKsystems and TEKsystems Global Services. We accelerate business transformation for our customers, so they can capitalize on change and master the momentum of technology. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We’re building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies.

Clinical Quality Assurance Coordinator – SIU Division Location: Remote Experience Level: Intermediate Overview We are seeking detail‑oriented and clinically strong Registered Nurses (RNs) or Licensed Vocational/Practical Nurses (LVNs/LPNs) to join our client’s Special Investigative Unit (SIU) as Clinical Quality Assurance Coordinators . In this role, you will support the review of medical services, validate accuracy, and ensure compliance with policies, criteria, and fraud‑waste‑abuse (FWA) standards. You will partner closely with Client Coordinators who process applications and referrals, then rely on you to complete the clinical quality review and communicate findings back to clients.

Conduct detailed quality assurance reviews of processed referrals and applications. Verify accuracy of surgeon selection, specialty alignment, and State Insurance usage. Confirm that requested services were completed exactly as ordered—no more, no less. Assess whether services met clinical policies, criteria, and medical necessity. Identify irregularities such as upcoding, unbundling, incorrect modifier usage, or unusual billing patterns. Prepare clear, grammatically accurate reports summarizing findings and clinical rationale. Communicate results to clients via phone and email with professionalism and clarity. Manage quick‑turnaround cases and prioritize workload effectively.