Clinical Quality Assurance Coordinator

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Conduct quality assurance evaluations of peer review documents, correspondence, addendums, or supplemental reviews.

• Ensure all recommendations and/or determinations are backed by clear, concise, evidence-based rationales.

• Confirm adherence to client instructions and specifications while addressing all inquiries.

• Verify that reviews are substantiated by up-to-date clinical citations and references from reputable medical journals and publications when applicable.

• Ensure that the report content, format, and professional presentation align with company standards.

• Confirm that the appropriate board specialty has reviewed each case in accordance with client specifications or state regulations and that this is accurately documented.

• Validate peer reviewer attestation regarding facts and the absence of conflicts of interest.

• Ensure that provider credentials and signatures are incorporated into the final report.

• Identify inconsistencies within reports and engage Peer Reviewers for clarification, modifications, or corrections.

• Assist in addressing client complaints and quality assurance concerns.

• Ensure compliance with federal ERISA regulations and state mandates.

• Provide management with insights regarding consultant quality, availability, and compliance.

• Advocate for the efficient and effective utilization of company resources.

• Engage in educational and training initiatives.

• Perform additional duties as required.

⛳️ Requirements

• Valid nursing license.

• Prior professional writing experience preferred.

• Strong understanding of medical terminology, anatomy and physiology, medications, and laboratory values.

• Capability to perform arithmetic with whole numbers and decimals, and to compute rates and percentages.

• Proficient typist; minimum 40 W.P.M. preferred.

• Competency in operating a computer, fax machine, copier, scanner, and telephone.

• Familiarity with Microsoft Word, Outlook, Excel, and the Internet.

• Excellent command of English usage, grammar, punctuation, and style.

• Ability to follow instructions and accurately respond to directives from upper management.

• Demonstrated accuracy and thoroughness.

• Commitment to improve and promote quality while monitoring personal work.

• Exceptional communication skills, including the capacity to convey accurate information, listen effectively, and ask clarifying questions.

• Ability to work independently, prioritize tasks, and manage time effectively.

• Capacity to maintain confidentiality.

• Ability to foster a positive team-oriented environment.

🏝️ Benefits

• 100% Remote - Eliminate the commute and work from home.

• Work-Life Balance - Monday-Friday, 7:30am-4:00pm CT.

• Supportive leadership.

• Strong benefits package.

• Opportunities for career advancement.

• Competitive benefits including medical, vision, and dental coverage.

• Paid time off.

• 401k plan.