Clinical Quality Assurance Coordinator

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

📋 Description

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

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

• Confirm adherence to client instructions, specifications, inquiries, clinical citations, and current reputable references.

• Maintain report content, format, professional appearance, and compliance with company standards.

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

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

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

• Detect report inconsistencies and reach out to peer reviewers for clarification, modifications, or corrections.

• Assist in handling customer complaints and addressing quality assurance concerns.

• Ensure compliance with federal ERISA regulations and state mandates.

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

• Encourage effective utilization of company resources.

• Engage in educational and training activities.

• Execute other duties as assigned.

⛳️ Requirements

• Must possess an active RN/LPN nursing license.

• A graduate from an accredited nursing program or have relevant medical experience is required.

• A Bachelor's degree is preferred.

• A minimum of two years of clinical or related field experience, or an equivalent combination of education and experience.

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

• Competence in performing arithmetic calculations involving whole numbers and decimals as well as computing rates and percentages.

• Proficient typist with a minimum typing speed of 40 words per minute.

• Capable of operating a computer, fax machine, copier, scanner, and telephone.

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

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

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

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

• Ability to maintain confidentiality.

🏝️ Benefits

• Medical insurance

• Vision insurance

• Dental insurance

• Paid time off

• 401(k)