Clinical Quality Assurance Coordinator

MCMC Services, LLC; United States; Remote; Full time

Job summary

A leading healthcare company is seeking a Clinical Quality Assurance Coordinator to ensure exceptional quality in peer review case reports. This remote position requires a nursing license and offers a dynamic work environment with competitive benefits. Join a team that prioritizes excellence and integrity while working from home.

Benefits

Medical Benefits

Vision Benefits

Dental Benefits

Paid Time Off

401k

Qualifications

• Active nursing license required.
• Graduate of an accredited nursing program or related medical experience.
• Strong knowledge of medical terminology and anatomy.

Responsibilities

• Perform quality assurance review of peer review reports.
• Ensure compliance with client specifications and state mandates.
• Assist in resolution of client complaints.

Skills

Medical Terminology

Anatomy and Physiology

Communication

Confidentiality

Education

Bachelor's Degree

Accredited Nursing Program

Tools

Microsoft Word

Microsoft Outlook

Microsoft Excel

Job description

Job Details

Job Location: Rockville, MD

Position Type: Full Time

Salary Range: $24.00 - $31.00 Hourly

Travel Percentage: None

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?

MCMC is looking for a self-driven, high-performing Nurse (LPN, LVN or 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, 11:30am-8:00pm EST, with occasional holiday coverage and possible weekend coverage as needed.

Could you be our next great addition to the MCMC family? Let's find out!

Duties and responsibilities may include:

• 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 contacts 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

• Active nursing license required.
• Must be a graduate of an accredited nursing program or related medical experience; bachelor's degree preferred.
• Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
• Must be a qualified typist with a minimum of 40 W.P.M
• 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.
• Must be able to stay focused and concentrate under normal or heavy distractions.
• Must be able to work well under pressure and or stressful conditions.
• Must possess the ability to manage change, delays, or unexpected events appropriately.
• Demonstrates reliability and abides by the company attendance policy.

MCMCcompletes over 100,000 reviews each year for more than 400 clients, including almost all of the nation’s largest Health Plans, PBMs, Disability Carriers, TPAs, UR companies, Self-Insured Employers, Taft-Hartley Plans and Government Organizations.

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.

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