Clinical Quality Assurance Coordinator

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

📋 Description

• Conduct quality assurance evaluations of peer review reports, correspondence, addendums, and supplementary reviews.

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

• Confirm that client instructions, specifications, and inquiries have been thoroughly addressed.

• Verify that clinical citations and current references from reputable medical journals or publications are included when applicable.

• Ensure that the content, format, appearance, and compliance of reports meet company standards.

• Validate appropriate board specialty reviews and accurate documentation of case reports.

• Check peer-reviewer attestations and ensure there are no conflicts of interest.

• Confirm that provider credentials and signatures are present in final reports.

• Identify inconsistencies in reports and reach out to peer reviewers for clarification, modifications, or corrections.

• Assist in addressing client complaints and quality assurance concerns.

• Ensure adherence to federal ERISA and state mandates.

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

• Encourage the effective and efficient utilization of company resources.

• Engage in educational and training initiatives.

• Carry out other assigned responsibilities.

⛳️ Requirements

• Open solely to Registered Nurses (RNs).

• Valid nursing license.

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

• Capability to perform arithmetic operations with whole numbers and decimals, as well as calculate rates and percentages.

• Proficient typing skills; a minimum of 40 W.P.M. is desired.

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

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

• Excellent skills in English usage, grammar, punctuation, and style.

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

• Strong accuracy and attention to detail.

• Outstanding communication abilities.

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

• Commitment to maintaining confidentiality.

• Ability to foster and promote a positive team-oriented atmosphere.

🏝️ Benefits

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

• Work-Life Balance - Monday through Friday, from 10:00 AM to 6:30 PM CT.

• Supportive leadership.

• Comprehensive benefits package.

• Opportunities for career advancement.

• Medical, vision, and dental coverage.

• Paid time off.

• 401k plan.