Clinical Quality Assurance Coordinator (32574)

About the role

MES is seeking a self-driven, high-performing RN or LPN to join their dynamic team as a Clinical Quality Assurance Coordinator. This role combines clinical skill development with the flexibility of working remotely from 12:00pm - 8:30pm EST on weekdays.

Responsibilities

• 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 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.
• 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.

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 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.
• Accuracy and thoroughness in following instructions and responding to upper management’s directions.
• Exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
• Ability to work independently, prioritize work activities and use time efficiently.
• Confidentiality and adherence to company policies.

Benefits

MES offers a fast-paced team atmosphere with competitive benefits including medical, vision, dental, paid time off, and a 401k plan.