Clinical Quality Assurance Coordinator

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

📋 Description

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

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

• Verify that client instructions, specifications, inquiries, clinical citations, references, report quality, and company standards are met.

• Confirm that appropriate board specialty reviews and accurate documentation are present in case reports.

• Validate peer reviewer attestations and check for the absence of conflicts of interest.

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

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

• Assist in addressing customer complaints and quality assurance concerns.

• Ensure adherence to ERISA, state mandates, client specifications, and company policies.

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

• Encourage the efficient use of company resources.

• Engage in required educational and training programs.

• Carry out other assigned responsibilities.

⛳️ Requirements

• A valid RN/LPN nursing license is essential.

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

• A minimum of two years of clinical or related field experience, or an equivalent combination of education and experience is required.

• A Bachelor's degree is preferred.

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

• Capability to perform arithmetic calculations involving whole numbers and decimals, as well as compute rates and percentages.

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

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

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

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

• Ability to accurately follow instructions.

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

• Must maintain confidentiality at all times.

🏝️ Benefits

• Fully remote work opportunity.

• Comprehensive medical, vision, and dental benefits.

• Paid time off provided.

• 401k retirement plan.

• No travel is required.