RN- Clinical Quality Reviewer - Nurse, Senior
Listed compensation
$91k-$154k
Confirm guaranteed pay, incentives and eligibility with the employer.
- Employment & setting
- Full-Time · hybrid
- Call expectations
- Not specified
- Weekends
- Not specified
Job description
Join Blue Shield of California as a RN Clinical Quality Reviewer – Hybrid, Senior Nurse in El Dorado Hills, CA, United States. Your Role The Clinical Quality Review (CQR) team is responsible for reviewing potential quality of care issues (PQIs) reported by a member, a member representative, or an internal or external partner. The Clinical Quality Reviewer – Nurse, Senior will report to the Manager, Clinical Quality Review.
Benefits & Compensation
- Salary: $91K - $154K
- Office environment
Work Schedule
- Full-Time position.
- Hybrid position - combination of remote and on-site.
This position offers hybrid flexibility. Work with Blue Shield of California in El Dorado Hills, CA, United States.
Key Responsibilities
Investigate potential quality of care issues and analyze medical records to make severity recommendations for medical directors. Prepare cases for peer review committees and issue corrective action requests to healthcare providers.
Requirements
Requires an Associate Degree in Nursing, a current California RN license, and at least 5 years of relevant case review experience. Must have experience working within a health plan and proven ability to present findings to medical directors.
Qualifications
- Experience
- 5+ years of experience
Key Skills
Ambulatory Care Nursing — Registered Nurse Career Context
Of the 50 active Ambulatory Care Nursing listings this role was benchmarked against, 34% are remote, 44% have no call, 58% require no weekends — this position is remote.
In California, the Ambulatory Care Nursing weighted monthly median benchmark on WeekdayDoc is ~$137k (25 salary observations; 46 listings), vs ~$97k nationally (386 salary observations; 930 listings). Monthly aggregates cover 2026-01-01 through 2026-09-01; these are not the modal's selected comparable-job medians.
The cost-of-living index for California is 110.7 (US average = 100; BEA Regional Price Parities (2024)), so the posted ~$122k midpoint carries the purchasing power of roughly $110k in an average-cost state. 63.6% of California clinicians report burnout symptoms in WeekdayDoc's Burnout Index (2026-01 data).
Blue Shield of California holds gold-tier status on WeekdayDoc's Top Employers work-life index, composite score 87/100, 11 active listings.
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- Hybrid