Clinical Quality Assurance Coordinator

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

📋 Description

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

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

• Confirm that client instructions, specifications, and inquiries have been adequately addressed.

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

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

• Verify that appropriate board specialty reviews and accurate documentation are completed.

• Confirm peer reviewer attestations and check for 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 or corrections.

• Assist in addressing customer complaints and managing quality assurance issues.

• Ensure adherence to federal ERISA and state regulations.

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

• Encourage the effective and efficient utilization of company resources.

• Engage in necessary educational and training activities.

• Carry out other assigned responsibilities.

⛳️ Requirements

• Active RN/LPN nursing license is mandatory.

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

• A Bachelor's degree is preferred.

• A minimum of 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 involving whole numbers, decimals, rates, and percentages.

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

• Capable of operating a computer, fax machine, copier, scanner, and telephone.

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

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

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

• Demonstrated attention to detail and thoroughness.

• Outstanding communication skills are required.

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

• Commitment to maintaining confidentiality.

🏝️ Benefits

• Medical insurance.

• Vision insurance.

• Dental insurance.

• Paid time off.

• 401(k).

• Fully remote work opportunity.

• Monday through Friday work schedule.