Clinical Quality Assurance Coordinator
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Job Description
Clinical QA Coordinator reviewing peer-review reports for MES, a medical examination and peer-review services provider. Ensuring evidence-based quality, regulatory compliance, and accurate clinical documentation.
Responsibilities:
- 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
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