Clinical Quality Assurance Coordinator

ExamWorks Group, Inc.; Boca Raton (FL); Remote; USD 60,000 - 90,000; Full time

Job summary

An exciting opportunity awaits a dedicated Registered Nurse to join a forward-thinking company as a Clinical Quality Assurance Coordinator. This role offers the unique advantage of working 100% remotely, allowing you to maintain a healthy work-life balance while contributing to impactful work. Your expertise will be pivotal in ensuring that peer review reports meet the highest standards of quality and compliance. If you're ready to leverage your clinical skills in a dynamic environment that values your contributions, this position is perfect for you. Join a team that is committed to excellence and make a difference in the healthcare industry today!

Qualifications

• 2+ years clinical experience required, with strong knowledge of medical terminology.
• RN licensure and Associate's degree are mandatory for this role.

Responsibilities

• Perform quality assurance reviews of peer reports ensuring compliance and integrity.
• Provide insights on consultant quality and assist in customer complaint resolutions.

Skills

Clinical knowledge

Medical terminology

Communication skills

Attention to detail

Time management

Education

Associate's degree

RN licensure

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

General computer skills

Job description

Overview

Ready for a New Challenge? Keep Your Clinical Skills Sharp—From Home!

Are you a Registered Nurse (RN) seeking a role that challenges you, helps you grow, and lets you work from the comfort of your own home? ExamWorks has the perfect opportunity for you!

We’re looking for a Clinical Quality Assurance Coordinator to join our team! In this role, you’ll be responsible for ensuring that Peer Review case reports meet the highest standards of quality, integrity, and compliance with client agreements, regulatory guidelines, and federal/state mandates.

Why This Role Rocks:

1. 100% Remote – Enjoy the flexibility of working from home!
2. Impactful Work – You’ll play a key role in ensuring the quality and compliance of critical reports.
3. Monday to Friday, 10:00am - 6:30pm EST—a schedule to keep your work-life balance on point.

If you’re a motivated, energetic nurse ready to take on an exciting new challenge, we want you on our team! At ExamWorks, we offer a dynamic environment where your skills will shine.

Excited? Apply today and take the next step in your career with a company that values your expertise and dedication. We can't wait to meet you!

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.
• Ensure that 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.
• 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.
• Assists in resolution of customer complaints and quality assurance issues as needed.
• Ensures all federal ERISA and/or state mandates are adhered to at all times.
• Provides insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.
• Promote effective and efficient utilization of company resources.
• Participate in various educational and or training activities as required.
• Perform other duties as assigned.

Qualifications

• Associate's degree required
• RN licensure required
• 2+ years clinical or related field experience; or equivalent combination of education and experience required
• Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability preferred
• Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values
• Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages
• Must be able to operate a general computer, fax, copier, scanner, and telephone
• Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet
• Must possess 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
• Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed
• Must be able to work independently, prioritize work activities and use time efficiently
• Must be able to maintain confidentiality
• Must be able to demonstrate and promote a positive team-oriented environment