Clinical Quality Assurance Coordinator
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Job Description
Clinical Quality Assurance Coordinator reviewing peer-review reports for MES Solutions, a provider of independent medical examinations and peer-review services. Ensuring clinical accuracy, regulatory compliance, and report quality remotely.
Responsibilities:
- Perform quality assurance review of peer review reports, correspondences, addendums, and supplemental reviews
- Ensure clear, concise, evidence-based rationales support recommendations and determinations
- Verify client instructions, specifications, questions, clinical citations, and current reputable references are followed
- Ensure report content, format, professional appearance, and compliance with company standards
- Verify appropriate board specialty review and accurate case-report documentation
- Verify peer-reviewer attestations 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, modification, or correction
- 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 utilization of company resources
- Participate in 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
- 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 perform arithmetic calculations with whole numbers and decimals and compute 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:
- Medical insurance
- Vision insurance
- Dental insurance
- Paid time off
- 401(k)
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