Clinical Quality Assurance Coordinator

MES Solutions; Norwood (MA); Remote; USD 60,000 - 90,000; Full time

Job summary

Ein innovatives Unternehmen sucht einen Clinical Quality Assurance Coordinator, der die Qualität und Compliance kritischer Berichte sicherstellt. In dieser 100% remote Position haben Sie die Flexibilität, von zu Hause aus zu arbeiten und einen bedeutenden Einfluss auf die Qualitätssicherung zu haben. Sie werden für die Überprüfung von Peer-Review-Berichten verantwortlich sein und sicherstellen, dass alle Anforderungen erfüllt sind. Wenn Sie eine Leidenschaft für medizinische Qualitätssicherung haben und in einem dynamischen Team arbeiten möchten, ist dies die perfekte Gelegenheit für Sie.

Benefits

Flexible Arbeitszeiten

Wettbewerbsfähige Leistungen

401k

Bezahlter Urlaub

Qualifications

• Mindestens zwei Jahre Erfahrung im klinischen Bereich oder verwandtem Bereich.
• Starke Kenntnisse in medizinischer Terminologie und Anatomie.

Responsibilities

• Durchführung von Qualitätsprüfungen von Peer-Review-Berichten.
• Sicherstellung der Einhaltung von Kundenanweisungen und -spezifikationen.

Skills

Medizinische Terminologie

Anatomie und Physiologie

Kommunikationsfähigkeiten

Computerkenntnisse

Typen (mindestens 40 W.P.M)

Education

Registered Nurse (RN)

Zwei Jahre klinische Erfahrung

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

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Description

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? MES 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

• 100% Remote – Enjoy the flexibility of working from home!
• Monday-Friday schedule. 1 day of 7:00am-3:30pm EST, 1 day of 9:00am-5:30pm EST, and 3 days of 10:00am-6:30pm EST. You will also be asked to work alternating weekends (once per month) and a holiday rotation (one summer, one winter holiday).
• Impactful Work – You’ll play a key role in ensuring the quality and compliance of critical reports.

Duties And Responsibilities

• Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.
• Ensure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
• Ensure that all client instructions and specifications have been followed and that all questions have been addressed.
• Ensure 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.
• Ensure the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
• Ensure the appropriate board specialty has reviewed the case in compliance with client specifications or state mandates and is documented accurately on the case report.
• Verify that the peer reviewer has attested to only the facts and that no evidence of reviewer conflict of interest exists.
• Ensure the provider credentials and signature are adhered to the final report.
• Identify any inconsistencies within the report and contact the Peer Reviewer to obtain clarification, modification or correction as needed.
• Assist in resolution of client complaints and quality assurance issues as needed.
• Ensure all federal ERISA and state mandates are adhered to at all times.
• Provide 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

• RN preferred.
• A minimum of two years clinical or related field experience; or equivalent combination of education and experience. Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: peer-review, external review, workers' compensation, no-fault, liability, and/or disability.
• 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 a qualified typist with a minimum of 40 W.P.M
• 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 management’s 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.

About MES Solutions

MES Solutions is a premier provider of independent medical examination and peer review services to the insurance, corporate, legal, and government sectors. We conduct physical examinations or medical record reviews, delivering reports to assist clients in resolving claims. Since 1978, MES has maintained the industry's highest standards of excellence and compliance.

Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, or protected veteran status.

We offer a fast-paced team environment with competitive benefits, paid time off, and 401k.

Interested?

Apply today and take the next step in your career with a company that values your expertise and dedication. We look forward to meeting you!