Remote Clinical Quality Assurance Specialist

Make an impact on healthcare quality as a detail-oriented Registered Nurse (RN) or Licensed Practical Nurse (LPN) with a passion for quality, compliance, and clinical excellence. Join our growing team and play a vital role in ensuring the accuracy, integrity, and compliance of clinical peer review reports.

About the role

This position is ideal for a nursing professional who enjoys analyzing clinical documentation, collaborating with medical professionals, and helping maintain the highest standards of healthcare quality.

Responsibilities

• Perform comprehensive quality assurance reviews of peer review reports, correspondence, addendums, and supplemental reviews.
• Verify that all recommendations and determinations are supported by clear, concise, evidence-based clinical rationale.
• Ensure client instructions, specifications, and case questions have been fully addressed.
• Review clinical citations and references for accuracy, relevance, and currency.
• Ensure reports maintain the highest standards of professionalism, quality, formatting, and presentation.
• Verify appropriate physician specialty reviews are completed in accordance with client requirements and state mandates.
• Confirm reviewer attestations, provider credentials, signatures, and conflict-of-interest requirements are properly documented.
• Identify report inconsistencies and collaborate with peer reviewers to obtain clarifications, corrections, or modifications.
• Support the resolution of client concerns and quality assurance issues.
• Ensure adherence to federal ERISA regulations, state mandates, and internal compliance standards.
• Provide feedback to leadership regarding consultant quality, compliance, and availability.
• Participate in training, educational opportunities, and quality improvement initiatives.
• Assist with additional projects and duties as assigned.

Requirements

• Current, active RN or LPN license required.
• Strong clinical knowledge and understanding of medical terminology and healthcare documentation.
• Exceptional attention to detail and analytical skills.
• Ability to work independently and manage priorities effectively.
• Strong written and verbal communication skills.
• Reliable, organized, and self-motivated professional.

Qualifications

Preferred Qualifications

• CPC (Certified Professional Coder) certification.
• Medical coding or healthcare documentation review experience.
• Prior quality assurance, utilization review, peer review, case management, or clinical compliance experience.
• Knowledge of ERISA, regulatory compliance, and healthcare quality standards.

Skills

• Clinical Quality Assurance
• Medical Record Review
• Healthcare Compliance
• CPC Coding
• Clinical Documentation Review
• Quality Improvement
• Regulatory Compliance
• Utilization Review
• Case Review
• Medical Terminology
• Attention to Detail
• Independent Decision-Making

Benefits

If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital insurance
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

Pay

The pay range for this position is $26.50 - $28.50/hr. Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

Schedule

This is a fully remote, Contract to Hire position based out of Rockford, IL.

Experience Level: Entry-Level to Early Career