Clinical Quality Assurance Coordinator

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

📋 Description

• Conducts quality assurance evaluations of peer review reports, correspondences, addendums, or supplemental reviews.

• Ensures that clear, concise, and evidence-based rationales are provided to support all recommendations and/or determinations.

• Confirms adherence to all client instructions and specifications while ensuring all inquiries have been addressed.

• Verifies that each review is supported by clinical citations and references when applicable, ensuring all cited references are current and sourced from reputable medical journals and/or publications.

• Ensures that the content, format, and professional presentation of the reports meet the highest quality standards and comply with company policies.

• Confirms that the appropriate board specialty has reviewed the case in accordance with client specifications and/or state mandates, with accurate documentation on the case report.

• Verifies that the peer reviewer has attested only to the facts and that there is no evidence of a reviewer conflict of interest.

• Ensures that provider credentials and signatures are included in the final report.

• Identifies any discrepancies in the report and reaches out to the Peer Reviewer for clarification, modification, or correction as necessary.

• Assists in resolving customer complaints and quality assurance issues as required.

• Ensures compliance with all federal ERISA and/or state mandates at all times.

• Provides management with insights and guidance on consultant quality, availability, and adherence to all company policies and client specifications.

• Encourages the effective and efficient use of company resources.

• Participates in various educational and training activities as needed.

• Performs additional duties as assigned.

⛳️ Requirements

• Active RN/LPN nursing license is required.

• Must have graduated from an accredited nursing program or have related medical experience; 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 is necessary.

• Must possess a strong understanding of medical terminology, anatomy and physiology, medications, and laboratory values.

• Must be able to perform addition, subtraction, multiplication, and division in all units of measure, using whole numbers and decimals; ability to compute rates and percentages is required.

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

• Must be capable of operating general office equipment, including computers, fax machines, copiers, scanners, and telephones.

• Must be knowledgeable in various software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.

• Must demonstrate excellent proficiency in English usage, grammar, punctuation, and style.

• Ability to follow instructions and respond accurately to upper management's directives is essential.

• Demonstrates accuracy and thoroughness in all tasks.

• Actively seeks opportunities to enhance quality and monitors personal work to ensure standards are met.

• Must exhibit exceptional communication skills by accurately conveying necessary information, listening effectively, and asking questions for clarification as needed.

• Must be capable of working independently, prioritizing work tasks, and managing time efficiently.

• Must maintain confidentiality at all times.

🏝️ Benefits

• Competitive benefits package (including medical, vision, and dental).

• Paid time off.

• 401k plan.