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 supplemental assessments.

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

• Verify that client instructions, specifications, and inquiries are thoroughly addressed.

• Confirm that clinical citations and references are up-to-date and sourced from reputable medical journals or publications.

• Ensure that the content, format, and professional appearance of reports adhere to company standards.

• Validate the appropriateness of board specialty reviews and maintain accurate documentation.

• Confirm peer reviewer attestations and check for any conflicts of interest.

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

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

• Assist with customer complaints and address quality assurance concerns.

• Ensure adherence to federal ERISA regulations and state mandates.

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

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

• Engage in required educational and training sessions.

• Carry out other duties as assigned.

⛳️ Requirements

• An active RN/LPN nursing license is required.

• Must be a graduate of an accredited nursing program or possess 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 required.

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

• Ability to perform arithmetic calculations with whole numbers, decimals, rates, and percentages.

• Proficient typing skills, with a minimum of 40 words per minute.

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

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

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

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

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

• Commitment to maintaining confidentiality.

🏝️ Benefits

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

• Paid time off.

• 401k.