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100% REMOTE Clinical Quality Assurance Coordinator ID - 16666

About the position

The Clinical Quality Assurance Coordinator is a remote position responsible for ensuring the quality and integrity of Peer Review case reports in compliance with client agreements and regulatory standards. The role involves reviewing reports, ensuring adherence to specifications, and providing insights to management on quality and compliance issues. This position requires strong clinical knowledge and attention to detail, with a focus on maintaining high standards in report quality.

Responsibilities

  • Performs quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.
  • Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
  • Ensures that all client instructions and specifications have been followed and that all questions have been addressed.
  • Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.
  • Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
  • Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.
  • Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.
  • Ensures the provider credentials and signature are adhered to the final report.
  • Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.
  • Assists in resolution of customer complaints and quality assurance issues as needed.
  • Ensures all federal ERISA and/or state mandates are adhered to at all times.
  • Provides insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.
  • Promote effective and efficient utilization of company resources.
  • Participate in various educational and or training activities as required.
  • Perform other duties as assigned.

Requirements

  • High school diploma or equivalent required.
  • A 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 add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages.
  • Qualified typist with a minimum of 40 W.P.M.
  • Ability to operate a general computer, fax, copier, scanner, and telephone.
  • Knowledgeable of multiple software programs, including Microsoft Word, Outlook, Excel, and the Internet.
  • Excellent skills in English usage, grammar, punctuation and style.
  • Ability to follow instructions and respond to upper management's directions accurately.
  • Demonstrates accuracy and thoroughness.
  • Ability to work independently, prioritize work activities and use time efficiently.
  • Ability to maintain confidentiality.
  • Ability to demonstrate and promote a positive team-oriented environment.
  • Ability to stay focused and concentrate under normal or heavy distractions.
  • Ability to work well under pressure and/or stressful conditions.
  • Demonstrates reliability and abides by the company attendance policy.

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Benefits

  • Medical insurance
  • Vision insurance
  • Dental insurance
  • Paid time off
  • 401k
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