Clinical Quality Assurance Coordinator
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Job Description
ExamWorks healthcare services coordinator reviewing medical records and peer-review reports remotely. Ensuring evidence-based, compliant, accurate reports through clinical quality assurance and reviewer coordination.
Responsibilities:
- Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews
- Ensure clear, concise, evidence-based rationales support all recommendations and/or determinations
- Ensure client instructions and specifications are followed and all questions are addressed
- Ensure reviews are supported by current clinical citations and references from reputable medical journals and publications when applicable
- Ensure report content, format, and professional appearance meet company standards
- Ensure the appropriate board specialty has reviewed each case according to client specifications or state mandates and is accurately documented
- Verify peer reviewer attestation to facts and absence of conflicts of interest
- Ensure provider credentials and signature are included on the final report
- Identify report inconsistencies and contact Peer Reviewers for clarification, modification, or correction
- Assist with client 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 educational and training activities
- Perform other duties as assigned
Requirements:
- Nursing license
- Professional writing experience preferred
- Strong knowledge of medical terminology, anatomy and physiology, medications, and laboratory values
- Ability to perform arithmetic using whole numbers and decimals and compute rates and percentages
- Qualified typist; minimum 40 W.P.M. preferred
- 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 upper management directions
- Accuracy and thoroughness
- Ability to improve and promote quality and monitor own work
- Exceptional communication skills, including accurate information conveyance, effective listening, and clarification questions
- Ability to work independently, prioritize activities, and use time efficiently
- Ability to maintain confidentiality
- Ability to promote a positive team-oriented environment
Benefits:
- 100% Remote - Skip the commute and work from home
- Work-Life Balance - Monday-Friday, 7:30am-4:00pm CT
- Supportive leadership
- Strong benefits
- Opportunities for advancement
- Competitive benefits: medical, vision, dental
- Paid time off
- 401k
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