Clinical Quality Assurance Coordinator

MES Solutions, Inc.; Norwood (MA); Remote; USD 60,000 - 100,000; Full time

Job summary

An innovative firm is seeking a Clinical Quality Assurance Coordinator to ensure the quality and compliance of peer review reports. This remote role allows you to leverage your clinical expertise while working from home. You'll be responsible for conducting thorough reviews, ensuring adherence to regulatory guidelines, and maintaining high standards of report integrity. With a Monday-Friday schedule and the opportunity to impact critical healthcare services, this position is perfect for dedicated professionals looking to advance their careers in a supportive environment. Join a team that values your skills and offers a competitive benefits package!

Benefits

Medical Insurance

Vision Insurance

Dental Insurance

Paid Time Off

401k Plan

Qualifications

• Must be a registered nurse (RN) with clinical experience.
• Strong knowledge of medical terminology and anatomy is essential.

Responsibilities

• Perform quality assurance reviews of peer review reports.
• Ensure compliance with client instructions and regulatory guidelines.

Skills

Clinical Quality Assurance

Medical Terminology

Anatomy and Physiology

Communication Skills

Typing (40 W.P.M.)

Attention to Detail

Education

Registered Nurse (RN)

2 years clinical experience

Tools

Microsoft Word

Microsoft Outlook

Microsoft Excel

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? 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:

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-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).

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

• 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.

MES Solutions is a premier provider of independent medical examination and peer review services to the insurance, corporate, legal, and government sectors. Members of our credentialed medical panel conduct physical examinations or medical record reviews, delivering reports that assist clients in the resolution of automotive, disability, liability, and workers' compensation claims. MES has been providing services nationally since 1978 in accordance with the industry's highest standards of operating excellence and regulatory compliance.

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.

MES offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.

Equal Opportunity Employer - Minorities/Females/Disabled/Veterans

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