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, evidence-based rationales.

• Confirm adherence to client instructions, specifications, inquiries, clinical citations, and up-to-date reputable references.

• Verify that report content, formatting, presentation, and compliance align with company standards.

• Ensure appropriate board specialty reviews and accurate documentation are completed.

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

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

• Assist with customer complaints and address quality assurance concerns.

• Ensure compliance with federal ERISA regulations and state mandates.

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

• Encourage the efficient utilization of company resources.

• Engage in mandatory 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 related medical experience.

• 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 calculations involving whole numbers and decimals, including rates and percentages.

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

• Capability to operate 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 writing style.

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

• Demonstrated accuracy and attention to detail.

• Exceptional communication abilities.

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

• Commitment to maintaining confidentiality.

🏝️ Benefits

• Fully remote work environment.

• Comprehensive medical, vision, and dental benefits.

• Paid time off.

• 401k plan.

• Competitive benefits package.

• Opportunities for educational and training activities.