Clinical Quality Assurance Coordinator (32344)

About the role

MES is seeking a self-driven, high-performing Registered Nurse (RN) or Licensed Practical Nurse (LPN) to join their dynamic team as a Clinical Quality Assurance Coordinator. This role involves ensuring Peer Review case reports meet high standards of quality and integrity, while adhering to client agreements, regulatory standards, and state and federal mandates.

Responsibilities

• Perform quality assurance review of peer review reports, correspondences, addendums, or supplemental reviews.
• Ensure clear, concise, evidence-based rationales are provided in support of all recommendations and/or determinations.
• Ensure all client instructions and specifications are followed and all questions are addressed.
• Ensure the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
• Ensure 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.
• Identify any inconsistencies within the report and contact the Peer Reviewer to obtain clarification, modification, or correction as needed.
• Aid in resolving customer complaints and quality assurance issues as needed.
• Ensure all federal ERISA and/or state mandates are adhered to at all times.
• Provide 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

• Active RN/LPN nursing license required.
• Graduate of an accredited nursing program or 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 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 WPM.
• Knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
• Excellent skills in English usage, grammar, punctuation, and style.
• Able to follow instructions and respond to upper management’s directions accurately.
• Demonstrates accuracy and thoroughness; looks for ways to improve and promote quality and monitors own work to ensure quality is met.
• Exceptional communication skills by conveying necessary information accurately, listening effectively, and asking questions where clarification is needed.
• Able to work independently, prioritize work activities, and use time efficiently.
• Able to maintain confidentiality.

Qualifications

• Active RN/LPN nursing license required.
• Graduate of an accredited nursing program or 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 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 WPM.
• Knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
• Excellent skills in English usage, grammar, punctuation, and style.
• Able to follow instructions and respond to upper management’s directions accurately.
• Demonstrates accuracy and thoroughness; looks for ways to improve and promote quality and monitors own work to ensure quality is met.
• Exceptional communication skills by conveying necessary information accurately, listening effectively, and asking questions where clarification is needed.
• Able to work independently, prioritize work activities, and use time efficiently.
• Able to maintain confidentiality.

Skills

• Quality assurance review
• Medical terminology
• Anatomy and physiology
• Medications and laboratory values
• Computer proficiency (Microsoft Word, Outlook, Excel)
• Communication skills
• Time management
• Confidentiality

Benefits

• Competitive benefits (medical, vision, dental)
• Paid time off
• 401k

Pay

Compensation is commensurate with experience.

Schedule

The position is 100% remote with a schedule of Monday through Friday: early 8:00am-4:30pm/ 9:00am-5:30pm or late 12:00pm-8:30pm. Occasional weekends.

Company Information

MES Solutions is a premier provider of independent medical examination and peer review services to the insurance, corporate, legal, and government sectors. Members of our credentialed medical panel conduct physical examinations or medical record reviews, delivering reports that assist clients in the resolution of automotive, disability, liability, and workers' compensation claims. MES has been providing services nationally since 1978 in accordance with the industry's highest standards of operating excellence and regulatory compliance.

Equal Opportunity Employer

MES is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.