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 supplementary reviews.

• Ensure that clear, concise, evidence-based justifications support recommendations and conclusions.

• Confirm that client instructions, specifications, inquiries, citations, and references are addressed and up-to-date.

• Guarantee that reports comply with company standards for content, formatting, and professional presentation.

• Validate appropriate board specialty reviews and accurate documentation.

• Confirm peer reviewer attestation and 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 corrections.

• Assist with 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 efficient utilization of company resources.

• Engage in required educational and training opportunities.

• Perform additional assigned tasks.

⛳️ Requirements

• Active RN or LPN nursing license is essential.

• Graduate from 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.

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

• Ability to perform basic arithmetic and calculate rates and percentages.

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

• Capable of 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 style.

• Ability to accurately follow instructions and management directives.

• Attention to detail and thoroughness.

• Exceptional communication abilities.

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

• Ability to maintain confidentiality.

🏝️ Benefits

• Fully remote work opportunity.

• Medical, vision, and dental benefits.

• Paid time off.

• 401k plan.

• No travel required.