Clinical Quality Assurance Coordinator

Job Description:

• Perform quality assurance reviews of peer review reports, correspondences, addendums, and supplemental reviews
• Ensure clear, concise, evidence-based rationales support recommendations and determinations
• Verify client instructions, specifications, and questions have been 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
• Confirm peer reviewer attestation and absence of conflicts of interest
• Ensure provider credentials and signature are included in final reports
• Identify report inconsistencies and contact peer reviewers for clarification or correction
• Assist with customer complaints and quality assurance issues
• Ensure compliance with federal ERISA and state mandates
• Provide management with insight into consultant quality, availability, and compliance
• Promote effective and efficient use of company resources
• Participate in required educational and training activities
• Perform other assigned duties

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
• Demonstrated accuracy and thoroughness
• Exceptional communication skills
• Ability to work independently, prioritize work, and use time efficiently
• Ability to maintain confidentiality

Benefits:

• Medical insurance
• Vision insurance
• Dental insurance
• Paid time off
• 401(k)
• Fully remote work
• Monday through Friday schedule