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 supplemental reviews.

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

• Confirm that client instructions, specifications, and inquiries are adequately addressed.

• Guarantee that reviews incorporate current and reputable clinical citations and references when relevant.

• Ensure that the content, format, and professional appearance of reports align with company standards.

• Verify appropriate specialty board reviews and accurate case-report documentation.

• Check peer-reviewer attestations and the absence of conflicts of interest.

• Ensure that provider credentials and signatures are included in final reports.

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

• Assist with client complaints and quality assurance concerns.

• Ensure adherence to federal ERISA and state regulations.

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

• Encourage the effective and efficient use of company resources.

• Participate in mandatory educational and training sessions.

• Carry out other assigned responsibilities.

⛳️ Requirements

• Exclusively open to Registered Nurses (RNs).

• Possession of a valid nursing license.

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

• Ability to perform arithmetic calculations involving whole numbers and decimals.

• Capability to compute rates and percentages.

• Qualified typist; a minimum of 40 W.P.M. is preferred.

• Proficient 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 respond accurately to directives from upper management.

• Demonstrated accuracy and thoroughness.

• Exceptional communication abilities.

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

• Ability to maintain confidentiality.

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

🏝️ Benefits

• 100% Remote - Work from home and eliminate the commute.

• Work-Life Balance - Monday to Friday, 8:00am to 4:30pm CT.

• Supportive leadership.

• Comprehensive benefits.

• Opportunities for career advancement.

• Medical, vision, and dental coverage.

• Paid time off.

• 401k plan.