Clinical Quality Assurance Coordinator

MES Solutions; Norwood (MA); Remote; USD 71,000 - 95,000; Full time

Job summary

MES Solutions is seeking a Clinical Quality Assurance Coordinator to ensure high standards in peer review case reports. This remote position requires clinical expertise in nursing, a keen eye for detail, and the ability to ensure compliance with all regulations and standards. Enjoy a flexible schedule while contributing to significant impacts in healthcare.

Qualifications

• Must have an active nursing license.
• Graduate from an accredited nursing program preferred.
• At least two years of clinical experience required.

Responsibilities

• Perform quality assurance review of peer review reports and documentation.
• Ensure compliance with client and regulatory specifications.
• Assist in the resolution of quality assurance issues.

Skills

Clinical skills

Attention to detail

Communication skills

Problem-solving

Education

Active nursing license

Bachelor's degree in nursing or related field

Job description

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Description

Ready for a Rewarding Career that Fits Your Lifestyle?

Imagine a job where you can keep your

Description

Ready for a Rewarding Career that Fits Your Lifestyle?

Imagine a job where you can keep your clinical skills sharp, tackle exciting challenges, AND work from the comfort of your own home. Sounds like the perfect mix, right?

MES is looking for a self-driven, high-performing Registered Nurse (RN) to join our dynamic team as a Clinical Quality Assurance Coordinator. In this role, you’ll ensure our Peer Review case reports are nothing short of exceptional—delivering top-notch quality and integrity, all while staying fully aligned with client agreements, regulatory standards, and state and federal mandates.

The position is 100% remote with a schedule of Monday through Friday with rotating weekend shifts. You can start your day anytime between 7:00am-9:00am and end between 3:30pm-5:30pm EST with 1 late night per week from 12:00pm-8:30pm EST.

• 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.
  
  

If you’re ready to make a real impact in healthcare, all while enjoying the flexibility of working remotely, we want to hear from you!

Qualifications

• Active nursing license required.
• Must be a graduate of an accredited nursing program or related medical experience; bachelor's degree preferred.
• A minimum of two years clinical or related field experience; or equivalent combination of education and experience.
• 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 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.
  
  

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.

Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Quality Assurance

• Industries

  Insurance

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