Remote Clinical QA Coordinator - RN Preferred

Mes-Solutions; Norwood (MA); On-site; USD 62,000 - 65,000; Full time

Benefits offered by this job

Remote work

Flexible hours

Training program

Great benefits

Job summary

Mes-Solutions is seeking an RN to join as Clinical Quality Assurance Coordinator. The role involves deep review of medical records, narrative summaries, and QA oversight. Remote-friendly with structured hours and training to support success.

You will ensure evidence-based rationales, accuracy, and compliance with client specifications and regulatory standards while collaborating with the team to resolve issues and improve processes.

Qualifications

• High school diploma or equivalent required.
• A minimum of two years clinical or related field experience.
• Knowledge of the insurance industry, preferably claims management relative to workers' compensation, no-fault, liability, or disability preferred.
• HIPAA regulations and compliance knowledge recommended.
• Must be able to type at least 40 WPM.
• Proficiency with Microsoft Word, Outlook, Excel.

Responsibilities

• Performs quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.
• Ensures clear, evidence-based rationales accompany all recommendations and determinations.
• Ensures client instructions and specifications are followed and questions addressed.
• Verifies references are current and sourced from reputable journals and publications.
• Maintains professional appearance and formatting of reports per company standards.
• Ensures appropriate board specialty review per client specs and state mandates.
• Identifies inconsistencies and obtains clarifications as needed from peers.
• Assists in resolving customer complaints and QA issues.
• Adheres to ERISA and state mandates at all times.
• Provides guidance on consultant quality, availability and policy compliance.
• Promotes efficient use of company resources.
• Participates in training activities.

Skills

Medical terminology

HIPAA compliance

40 WPM typing

Microsoft Word

Microsoft Outlook

Microsoft Excel

Strong communication

Confidentiality

Independent worker

Education

High school diploma or equivalent

Two years clinical or related field experience

Tools

Microsoft Word

Outlook

Excel

Internet

Job description

Mes-Solutions is seeking an RN to join as Clinical Quality Assurance Coordinator. The role involves deep review of medical records, narrative summaries, and QA oversight. Remote-friendly with structured hours and training to support success.

You will ensure evidence-based rationales, accuracy, and compliance with client specifications and regulatory standards while collaborating with the team to resolve issues and improve processes.