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 supplementary reviews.

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

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

• Verify that the content, format, and professional presentation of reports align with company standards.

• Ensure that the appropriate board specialty review is conducted and that case-report documentation is accurate.

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

• Identify inconsistencies within reports and reach out to peer reviewers for clarification, modifications, or corrections.

• Assist in managing customer complaints and quality assurance concerns.

• Ensure adherence to federal ERISA regulations and state mandates.

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

• Encourage the efficient use of company resources.

• Engage in educational and training initiatives.

• Carry out other assigned responsibilities.

⛳️ Requirements

• An active RN/LPN nursing license is mandatory.

• 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 relevant field experience, or an equivalent combination of education and experience is required.

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

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

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

• 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 stylistic skills.

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

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

• Ability to maintain confidentiality.

🏝️ Benefits

• Fully remote work arrangement.

• Medical, vision, and dental benefits.

• Paid time off.

• 401k plan.

• Competitive benefits package.