Clinical Quality Assurance Coordinator

Job Description:

• Perform quality assurance reviews of peer review reports, correspondence, addendums and supplemental reviews
• Ensure clear, concise, evidence-based rationales support recommendations and determinations
• Verify client instructions, specifications and questions are addressed
• Confirm clinical citations and references are current and from reputable medical journals or publications
• Ensure report content, format and professional appearance meet company standards
• Verify appropriate board specialty review and accurate documentation
• Verify peer reviewer attestation and absence of conflicts of interest
• Ensure provider credentials and signatures are included in final reports
• Identify report inconsistencies and contact peer reviewers for clarification or corrections
• Assist with customer complaints and quality assurance issues
• Ensure compliance with federal ERISA and state mandates
• Provide management insight on consultant quality, availability and compliance
• Promote effective and efficient use of company resources
• Participate in required educational and training activities
• Perform other duties as assigned

Requirements:

• Active RN/LPN nursing license required
• Must be a graduate of an accredited nursing program or have related medical experience
• Bachelor's degree preferred
• Minimum of two years clinical or related field experience, or equivalent combination of education and experience
• Strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values
• Ability to perform arithmetic calculations involving whole numbers and decimals, rates and percentages
• Qualified typist with a minimum of 40 W.P.M.
• Ability to operate a computer, fax, copier, scanner and telephone
• Knowledge of Microsoft Word, Outlook, Excel and the Internet
• Excellent English usage, grammar, punctuation and style
• Ability to follow instructions and respond accurately to management directions
• Ability to work independently, prioritize work and use time efficiently
• Ability to maintain confidentiality

Benefits:

• Competitive benefits (medical, vision, dental)
• Paid time off
• 401k