Clinical Quality Assurance Coordinator

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

📋 Description

• Conduct quality assurance evaluations of peer review documents, correspondence, addendums, and supplemental analyses.

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

• Confirm that client instructions, specifications, inquiries, clinical citations, and references are appropriately addressed.

• Ensure that reports adhere to company standards regarding content, format, professional presentation, and regulatory compliance.

• Verify that the appropriate board specialty review is conducted and that documentation is accurate.

• Check peer reviewer attestations, ensuring the absence of conflicts of interest, provider credentials, and signatures.

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

• Assist in addressing customer complaints and quality assurance concerns.

• Ensure adherence to federal ERISA and state regulations.

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

• Encourage effective utilization of company resources.

• Engage in educational and training initiatives.

• Carry out additional duties as assigned.

⛳️ Requirements

• An active RN/LPN nursing license is required.

• Must have graduated from an accredited nursing program or possess related medical experience.

• A Bachelor's degree is preferred.

• At least 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 and decimals, and to compute rates and percentages.

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

• Capability to operate a computer, fax machine, copier, scanner, and telephone.

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

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

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

• Proven accuracy and thoroughness in work.

• Outstanding communication skills.

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

• Capacity to maintain confidentiality.

🏝️ Benefits

• Fully remote work arrangement.

• Medical, vision, and dental benefits.

• Paid time off.

• 401k.

• Fast-paced team atmosphere.