Clinical Quality Assurance Coordinator

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

📋 Description

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

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

• Confirm that client instructions, specifications, questions, clinical citations, and current reputable references are adequately addressed.

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

• Ensure accurate documentation and appropriate board specialty review.

• Verify the attestation of peer reviewers and the absence of any conflicts of interest.

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

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

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

• Ensure adherence to federal ERISA and state mandates.

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

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

• Engage in required educational and training activities.

• Perform other assigned tasks as needed.

⛳️ Requirements

• An active RN or LPN nursing license is mandatory.

• Must be a graduate of an accredited nursing program or possess related medical experience.

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

• A Bachelor's degree is preferred.

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

• Ability to calculate rates and percentages is necessary.

• Must be a qualified typist with a minimum typing speed of 40 W.P.M.

• Proficiency in operating a computer, fax, copier, scanner, and telephone is required.

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

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

• Ability to follow instructions accurately is necessary.

• Exceptional communication skills are a must.

• Capability to work independently, prioritize tasks, and manage time effectively is required.

• Ability to maintain confidentiality is essential.

🏝️ Benefits

• Fully remote work.

• Medical, vision, and dental benefits.

• Paid time off.

• 401k.

• No travel required.