Clinical Quality Assurance Coordinator (RN) (32085)

Why You’ll Love This Role

• 100% Remote – Work from home!
• Flexible Hours – Monday-Friday 8:00am-4:30pm early shift (3 days), 10:00am-6:30pm (1 day), and 12pm-8:30pm (1 day)
• All ET
• Great Training – First 4-6 weeks of training with a preferred training schedule of 12:00pm-8:30pm EST

Essential Duties and 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.
• Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.
• Sets 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.

Qualifications

• Education and/or Experience: High school diploma or equivalent required. A minimum of two years clinical or related field experience; or equivalent combination of education and experience preferred.
• Knowledge: Strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
• Skills: Qualified typist with a minimum of 40 W.P.M, full understanding of HIPAA regulations and compliance, ability to operate a general computer, fax, copier, scanner, and telephone, knowledge of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet, exceptional communication skills, ability to follow instructions and respond to upper management’s directions accurately, demonstrates accuracy and thoroughness, ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.

Essential Competencies

• Knowledge: Strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
• Skills: Qualified typist with a minimum of 40 W.P.M, full understanding of HIPAA regulations and compliance, ability to operate a general computer, fax, copier, scanner, and telephone, knowledge of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet, exceptional communication skills, ability to follow instructions and respond to upper management’s directions accurately, demonstrates accuracy and thoroughness, ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to date.

Benefits

• MES is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.