Clinical Quality Assurance Coordinator

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

📋 Description

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

• Ensure that recommendations and determinations 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 reports adhere to company standards for content, format, professional appearance, and regulatory compliance.

• Ensure accurate documentation of specialty reviews and case reports.

• Validate peer-reviewer attestations and check for any conflicts of interest.

• Make certain that provider credentials and signatures are present in the final reports.

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

• Assist in addressing 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 the effective and efficient utilization of company resources.

• Engage in educational and training initiatives.

• Perform additional assigned responsibilities.

⛳️ Requirements

• An active RN or 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 related field experience, or an equivalent combination of education and experience is required.

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

• Ability to execute arithmetic calculations involving whole numbers, decimals, rates, and percentages.

• Proficient typist with a minimum typing 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 is essential.

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

• Ability to accurately follow instructions.

• Outstanding communication skills.

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

• Ability to maintain confidentiality at all times.

🏝️ Benefits

• Fully remote work opportunities.

• Comprehensive medical, vision, and dental benefits.

• Paid time off.

• 401k plan.

• No travel is required.