Clinical Quality Assurance Coordinator (32979)

About the role

MCMC is seeking a motivated, detail‑oriented RN, LPN or LVN to work remotely as a Clinical Quality Assurance Coordinator. In this role you will review Peer Review case reports to ensure they meet the highest standards of quality, accuracy, and compliance, applying your clinical expertise beyond direct patient care while making a meaningful impact. MCMC completes over 100,000 reviews each year for more than 400 clients, including many of the nation’s largest health plans, PBMs, disability carriers, TPAs, UR companies, self‑insured employers, Taft‑Hartley plans and government organizations. This opportunity offers 100% remote work, a predictable Monday‑Friday schedule (11:30 am – 8:00 pm EST with occasional weekend/holiday coverage), the chance to use your clinical skills in quality assurance and peer review, and the ability to help ensure the integrity of important clinical reviews that influence decision‑making every day.

Responsibilities

• Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.
• Ensure clear, concise, evidence‑based rationales support all recommendations and determinations.
• Verify that all client instructions and specifications are followed and that all questions are addressed.
• Confirm each review is supported by current clinical citations from reputable medical journals/publications.
• Check that the content, format, and professional appearance of reports meet company standards.
• Validate that the appropriate board specialty has reviewed the case per client specifications or state mandates and is documented accurately.
• Verify the peer reviewer has attested only to facts and that no conflict of interest exists.
• Ensure provider credentials and signature are adhered to the final report.
• Identify inconsistencies and contact the Peer Reviewer for clarification, modification or correction as needed.
• Assist in resolution of client complaints and quality assurance issues as needed.
• Ensure adherence to federal ERISA and state mandates at all times.
• Provide insight and direction to management on consultant quality, availability, and compliance with company policies and client specifications.
• Promote effective and efficient utilization of company resources.
• Participate in required educational and training activities.
• Perform other duties as assigned.

Qualifications

• Active nursing license (RN, LPN or LVN).
• Graduate of an accredited nursing program or related medical experience; bachelor’s degree preferred.
• Strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
• Minimum typing speed of 40 WPM.
• Proficiency with Microsoft Word, Outlook, Excel, and Internet.
• Excellent English usage, grammar, punctuation and style.
• Ability to follow instructions and respond to management directions accurately.
• Demonstrates accuracy, thoroughness, and a commitment to continuous quality improvement.
• Exceptional communication skills: conveying information accurately, listening effectively, asking clarifying questions.
• Ability to work independently, prioritize tasks, and use time efficiently.
• Maintain confidentiality.
• Promote a positive, team‑oriented environment.
• Stay focused and concentrate under normal or heavy distractions.
• Work well under pressure or stressful conditions.
• Manage change, delays, or unexpected events appropriately.

Benefits

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

Schedule

• 100% remote work.
• Predictable schedule: Monday through Friday, 11:30 am – 8:00 pm EST, with occasional weekend and holiday coverage.