Clinical Quality Assurance Coordinator (33044)

MES Solutions; United States; Remote; USD 60,000 - 86,000; Full time

Benefits offered by this job

Medical, Vision, Dental

Paid time off

401k plan

Job summary

MES Solutions is seeking a self-driven RN or LPN to join our team as a Clinical Quality Assurance Coordinator. This fully remote role focuses on QA of Peer Review case reports, ensuring accuracy, evidence-based rationales, and alignment with client agreements and regulatory standards.

You will review reports, ensure proper references, maintain confidentiality, and support management with quality improvements while complying with state and federal mandates.

Qualifications

• Active RN or LPN nursing license required.
• Graduate of an accredited nursing program; bachelor's preferred.
• Minimum two years clinical or related field experience.
• Strong knowledge of medical terminology, anatomy and physiology.
• Able to perform basic arithmetic and percentages.
• 40 WPM typing speed.
• Proficient with MS Word, Excel, Outlook and Internet.
• Excellent English usage, grammar, and style.
• Ability to work independently and manage time efficiently.
• Maintain confidentiality.

Responsibilities

• Perform quality assurance review of peer review reports and addendums.
• Provide evidence-based rationales for recommendations and determinations.
• Ensure client instructions and specifications are followed and questions answered.
• Cite clinical references from reputable journals; verify current sources.
• Ensure reports are high quality and compliant with standards.
• Ensure board specialty review aligns with client/state mandates.
• Verify reviewer confirmation of no conflicts of interest.
• Ensure credentials and signatures on final reports.
• Identify inconsistencies and obtain clarifications from Peer Reviewer.
• Assist in resolving customer complaints and QA issues.
• Adhere to ERISA and state mandates at all times.
• Provide guidance to management on quality and compliance.
• Promote efficient use of company resources.
• Participate in training activities.
• Perform other duties as assigned.

Skills

RN license

LPN license

Clinical knowledge

Excellent communication

Typing 40 WPM

Independent work

English proficiency

Education

Accredited nursing program

Bachelor's degree preferred

Tools

Microsoft Word

Microsoft Excel

Outlook

Internet

Job 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 RN or LPN 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: 11:00pm - 7:30pm 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.

Qualifications

• Active RN/LPN 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.

Equal Opportunity Employer - Minorities/Females/Disabled/Veterans

Benefits

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