Remote Clinical QA Coordinator Utilization Review

AllMed Medical Management; Portland (OR); Remote; USD 70,000 - 100,000; Full time

Benefits offered by this job

Medical benefits

Vision benefits

Dental benefits

Paid time off

401k

Job summary

AllMed Medical Management is seeking a Clinical Quality Assurance Coordinator to support 100% remote utilization review services. The role focuses on applying evidence-based guidelines to determine medical necessity and ensure accuracy and regulatory compliance across reviews.

The ideal candidate has nursing licensure and experience with URAC or IRO processes, strong medical knowledge, and the ability to work independently within Pacific Time business hours.

Qualifications

• Must hold and maintain an unencumbered Nursing license.
• URAC or IRO experience preferred.
• Remote work experience required.
• Strong knowledge of medical terminology, anatomy and physiology, medications and labs.
• Proficient typist and able to type at least 40 WPM.
• Knowledge of HIPAA regulations and compliance.
• Ability to operate standard office equipment and computers.
• Proficient with MS Word, Outlook, Excel and web resources.
• Excellent communication skills and attention to detail.
• Ability to follow directions and manage priorities independently.
• Maintain confidentiality and promote a positive team environment.

Responsibilities

• Perform quality utilization reviews using evidence-based guidelines.
• Collaborate with providers to determine level, intensity, and duration of care.
• Document findings and evaluate medical necessity for care frequency and length.
• Ensure reviews meet industry standards and client obligations.
• Adhere to turnaround times per client, URAC, and regulatory requirements.
• Maintain accurate utilization review records in the database.
• Coordinate with Customer Service to ensure timely delivery of determinations.
• Assist in resolving client complaints and quality issues.
• Support company policies and regulatory compliance in all reviews.
• Participate in meetings, training, and ongoing education.

Skills

Medical terminology

HIPAA compliance

Communication skills

Independent work

Time management

Education

Nursing license

Tools

Microsoft Word

Outlook

Excel

Internet

Job description

AllMed Medical Management is seeking a Clinical Quality Assurance Coordinator to support 100% remote utilization review services. The role focuses on applying evidence-based guidelines to determine medical necessity and ensure accuracy and regulatory compliance across reviews.

The ideal candidate has nursing licensure and experience with URAC or IRO processes, strong medical knowledge, and the ability to work independently within Pacific Time business hours.