Clinical Quality Assurance Coordinator (32445)

About the role

MES is seeking a self-driven, high-performing Registered Nurse (RN) to join our dynamic team as a Clinical Quality Assurance Coordinator. This role ensures that Peer Review case reports meet the highest standards of quality and integrity.

Responsibilities

• Performs quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.
• Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
• Ensures that all client instructions and specifications have been followed and that all questions have been addressed.
• Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.
• Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
• Ensures 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.
• Ensures the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.
• Ensures the provider credentials and signature are adhered to the final report.
• Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.
• Aids in resolving customer complaints and quality assurance issues as needed.
• Ensures all federal ERISA and/or state mandates are adhered to at all times.
• Promotes effective and efficient utilization of company resources.
• Participates in various educational and/or training activities as required.
• Provides insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.
• Performs other duties as assigned.

Requirements

• Active RN 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 W.P.M.
• 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.
• Ability to follow instructions and respond to upper managements’ 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 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 W.P.M.
• 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.
• Ability to follow instructions and respond to upper managements’ 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 of peer review reports.
• Clear, concise, evidence-based rationales.
• Follows client instructions and specifications.
• Ensures clinical citations and references are current.
• Ensures reports are of the highest quality and compliant with company standards.
• Ensures board specialty review and documentation.
• Ensures peer reviewer attestation and absence of conflict of interest.
• Ensures provider credentials and signature adherence.
• Identifies and resolves inconsistencies.
• Resolves customer complaints and quality assurance issues.
• Adheres to federal ERISA and state mandates.
• Promotes resource utilization and efficiency.
• Participates in educational and training activities.
• Provides insight and direction to management.

Benefits

• Medical, vision, dental coverage.
• Paid time off.
• 401(k) plan.

Pay

Competitive salary based on experience and qualifications.

Schedule

The position is 100% remote with a flexible schedule of Monday through Friday: 2 days: 8am-4:30pm EST, 1 day: 10am-6:30pm EST, 2 days: 12am-8:30pm EST (Friday is mandatory for one of the 12-8:30 shifts).

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.