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, correspondences, addendums, and supplemental reviews.

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

• Confirm adherence to client instructions, specifications, federal ERISA regulations, and state mandates.

• Verify that reviews include current, credible clinical citations and references when applicable.

• Ensure that report content, format, professional appearance, and compliance align with company standards.

• Validate appropriate board specialty review and accurate case-report documentation.

• Confirm peer reviewer attestation and the absence of conflicts of interest.

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

• Identify inconsistencies in reports and reach out to Peer Reviewers for clarification, modifications, or corrections.

• Assist with client complaints and quality assurance matters.

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

• Promote effective and efficient utilization of company resources.

• Engage in educational and training initiatives.

• Perform additional duties as assigned.

⛳️ Requirements

• Exclusively open to RN, LPN, or LVN candidates.

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

• Graduate from an accredited nursing program or possess related medical experience.

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

• Proficient typist with a minimum speed of 40 W.P.M.

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

• Excellent skills in English usage, grammar, punctuation, and style.

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

• Demonstrated accuracy and thoroughness.

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

• Ability to maintain confidentiality.

• Capability to thrive in a positive, team-oriented environment.

• Ability to maintain focus amidst normal or heavy distractions.

• Ability to perform well under pressure or stressful conditions.

• Ability to adapt to changes, delays, or unexpected events appropriately.

🏝️ Benefits

• 100% remote work from home.

• Predictable Monday–Friday schedule.

• Medical, vision, and dental benefits.

• Paid time off.

• 401k.

• Opportunities for professional growth.