Clinical Quality Assurance Coordinator
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Job Description
Clinical Quality Assurance Coordinator reviewing peer-review reports for MES Solutions’ independent medical examination and peer-review services. Ensuring clinical accuracy, regulatory compliance, and report quality remotely.
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, questions, clinical citations, and current reputable references are followed
- Ensure report content, format, appearance, and compliance meet company standards
- Confirm appropriate board specialty review and accurate documentation
- Verify peer reviewer attestations, absence of conflicts of interest, provider credentials, and signatures
- 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 efficient use of company resources
- Participate in required educational and training activities
- Perform other assigned duties
Requirements:
- Active RN/LPN nursing license required
- Graduate of an accredited nursing program or related medical experience
- 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 compute using whole numbers and decimals, including 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
- Accuracy and thoroughness
- Exceptional communication skills
- Ability to work independently, prioritize work, and use time efficiently
- Ability to maintain confidentiality
Benefits:
- Fully remote work
- Medical, vision, and dental benefits
- Paid time off
- 401k
- Competitive benefits
- Educational and training activities
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