Remote Clinical QA Coordinator - Utilization Review

AllMed Medical Management; United States; Remote; USD 55,000 - 85,000; Full time

Benefits offered by this job

Medical benefits

Vision and dental

401k

Paid time off

Job summary

AllMed is seeking a Clinical Quality Assurance Coordinator to perform quality utilization reviews and ensure medical necessity aligns with evidence-based guidelines. This 100% remote role supports Pacific Time Zone operations and may require occasional weekend coverage.

The candidate will document findings, uphold accuracy and integrity, and participate in ongoing training and regulatory compliance to deliver high-quality clinical outcomes.

Qualifications

• Must hold and maintain an unencumbered Nursing license.
• Strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
• Must have HIPAA compliance knowledge.
• Experience with URAC or regulatory guidelines is a plus.
• Remote work experience and ability to work Pacific Time Zone hours.

Responsibilities

• Perform quality utilization reviews using evidence-based guidelines for peer review reports and related documentation.
• Collaborate with providers to determine level, intensity and duration of care.
• Document findings and evaluate medical necessity for frequency, intensity and length of required care.
• Ensure reviews meet client, federal and URAC standards and turnaround times.
• Maintain accurate records of Utilization Reviews in the database and assist in issue resolution.

Skills

Attention to detail

Verbal and written communication

Time management

Quality mindset

Education

Nursing license

Tools

Microsoft Word

Microsoft Outlook

Excel

Internet

Job description

AllMed is seeking a Clinical Quality Assurance Coordinator to perform quality utilization reviews and ensure medical necessity aligns with evidence-based guidelines. This 100% remote role supports Pacific Time Zone operations and may require occasional weekend coverage.

The candidate will document findings, uphold accuracy and integrity, and participate in ongoing training and regulatory compliance to deliver high-quality clinical outcomes.