Clinical Quality Assurance Coordinator (33133)

MES Solutions; Winslows (MA); Remoto; USD 65.000 - 90.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical benefits

Vision and Dental

Paid time off

401k plan

Descrizione del lavoro

MES Solutions seeks a self-driven RN or LPN to join as Clinical Quality Assurance Coordinator. This 100% remote role offers a Monday–Friday schedule with EST work hours and occasional weekends/holidays.

You will review peer reports, ensure evidence-based rationales, and maintain compliance with client specs and regulations. The candidate will ensure high quality, citation-backed reports, proper signatures, and confidentiality while supporting resolution of QA issues and education activities

Competenze

• Active RN/LPN nursing license required.
• Graduate of an accredited nursing program or related medical experience; bachelor’s degree preferred.
• A minimum of two years clinical or related field experience.
• Strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
• Proficiency in basic math and ability to compute rates/percentages.
• Adequate typing speed (40 WPM) and computer skills (Word/Outlook/Excel).
• Excellent English usage, grammar, punctuation and style.

Mansioni

• Performs quality assurance review of peer review reports and related documents.
• Ensures evidence-based rationales accompany recommendations and determinations.
• Verifies client instructions are followed and questions answered.
• Ensures citations are current and from reputable journals.
• Maintains high-quality formatting and professional appearance of reports.
• Confirms appropriate board specialty review and documentation per client specs/state mandates.
• Verifies reviewer attestations and absence of conflicts of interest.
• Maintains confidentiality and handles customer complaints/QA issues as needed.
• Ensures adherence to ERISA/state mandates and company policies.

Conoscenze

RN/LPN license

Medical terminology

English proficiency

40 WPM typing

MS Office

Confidentiality

Time management

Formazione

Accredited nursing program graduate

Bachelor's degree preferred

Strumenti

Microsoft Word

Outlook

Excel

Internet

Descrizione del lavoro

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:

• 12:00am - 8:30pm EST
• occasional weekends and holidays

• 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

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