Clinical Quality Assurance Coordinator

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

📋 Description

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

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

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

• Verify that reports conform to company standards regarding content, format, professional appearance, and compliance.

• Validate appropriate board specialty review and documentation in accordance with client specifications or state mandates.

• Ensure peer reviewer attestation to facts and the absence of conflicts of interest.

• Confirm inclusion of provider credentials and signatures 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 matters.

• Ensure adherence to federal ERISA and state mandates.

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

• Encourage effective and efficient use of company resources.

• Participate in mandatory educational and training activities.

• Perform additional duties as assigned.

⛳️ Requirements

• Position is exclusively available to RN, LPN, or LVN candidates.

• An active nursing license (RN/LPN/LVN) is required.

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

• A Bachelor's degree is preferred.

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

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

• Proficiency in Microsoft Word, Outlook, Excel, and Internet navigation is necessary.

• Exceptional skills in English usage, grammar, punctuation, and style are required.

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

• Capable of working independently, prioritizing tasks, and managing time effectively.

• Must maintain confidentiality at all times.

• Ability to perform under pressure and in stressful situations.

• Capable of appropriately managing change, delays, or unexpected events.

🏝️ Benefits

• 100% remote work from home.

• Predictable Monday–Friday work schedule.

• Opportunities for professional growth.

• Competitive medical, vision, and dental benefits.

• Paid time off.

• 401(k) plan.