Clinical Quality Assurance Coordinator

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

📋 Description

• Conduct quality assurance evaluations of peer review documents, correspondence, addendums, and supplementary reviews.

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

• Confirm that client instructions and specifications are adhered to, with all queries addressed.

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

• Guarantee that report content, format, presentation, and compliance align with company standards.

• Ensure appropriate board specialty review and accurate documentation are in place.

• Confirm peer reviewer attestation and the absence of conflicts of interest.

• Make sure provider credentials and signatures are included in final reports.

• Identify inconsistencies in reports and reach out to peer reviewers for clarification or correction.

• Assist in addressing client complaints and quality assurance matters.

• Ensure adherence to federal ERISA and state mandates.

• Offer management insights regarding consultant quality, availability, and compliance.

• Encourage effective and efficient utilization of company resources.

• Engage in educational and training initiatives.

• Perform other assigned responsibilities.

⛳️ Requirements

• Position is exclusively available to RN, LPN, or LVN professionals.

• An active nursing license (RN/LPN/LVN) is mandatory.

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

• A Bachelor's degree is preferred.

• Strong familiarity with medical terminology, anatomy and physiology, medications, and laboratory values is essential.

• Must be a qualified typist with a minimum typing speed of 40 W.P.M.

• Proficiency in Microsoft Word, Outlook, Excel, and Internet navigation is required.

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

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

• Attention to detail, thoroughness, and quality monitoring are crucial.

• Outstanding communication skills are necessary.

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

• Must be capable of maintaining confidentiality.

• Ability to perform well under pressure or in stressful situations.

• Competence in managing changes, delays, or unforeseen events appropriately.

🏝️ Benefits

• 100% Remote – Enjoy the flexibility of working from home.

• Predictable Monday–Friday work schedule.

• Competitive benefits package including medical, vision, and dental coverage.

• Paid time off.

• 401k plan.

• Opportunities for educational and training activities.