Clinical Quality Assurance Coordinator

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

📋 Description

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

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

• Confirm adherence to client instructions and specifications, ensuring all inquiries are addressed.

• Verify that clinical citations and references are up-to-date and sourced from reputable medical journals or publications.

• Ensure that report content, format, and professional presentation meet company standards.

• Validate that the appropriate board specialty has reviewed each case in accordance with client specifications and state regulations.

• Confirm peer reviewer attestations and the absence of any 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, modifications, or corrections.

• Assist in addressing customer complaints and quality assurance concerns.

• Ensure compliance with federal ERISA and state regulations.

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

• Promote effective use of company resources.

• Engage in educational and training initiatives.

• Perform additional duties as assigned.

⛳️ Requirements

• An active RN or LPN nursing license is required.

• 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 related field experience, or a combination of education and experience equivalent.

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

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

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

• Capability to operate general office equipment such as computers, fax machines, copiers, scanners, and telephones.

• Proficient in Microsoft Word, Outlook, Excel, and the Internet.

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

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

• Proven accuracy and thoroughness in work.

• Exceptional communication skills.

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

• Ability to maintain confidentiality.

🏝️ Benefits

• Fully remote work arrangement.

• Competitive benefits package.

• Medical insurance.

• Vision insurance.

• Dental insurance.

• Paid time off.

• 401k plan.

• No travel required.