Remote Clinical Quality Assurance Coordinator

Ime Resources Llc; Southfield (MI); Remote; USD 55,000 - 85,000; Full time

Benefits offered by this job

Remote work

Medical coverage

Dental coverage

Vision coverage

401k plan

Job summary

ExamWorks is seeking a Clinical Quality Assurance Coordinator to ensure peer review reports meet high quality and regulatory standards. This role analyzes clinical documentation, ensures evidence-based rationales, and verifies references, credentials, and compliance with client specifications.

You will support resolution of client issues, advise management on quality controls, and participate in training while maintaining confidentiality and accuracy in a 100% remote, EST-based schedule.

Qualifications

• High school diploma or equivalent with at least two years clinical or related experience.
• Experience in peer review, clinical documentation review, or medical necessity assessments.
• Familiarity with CMS guidelines, InterQual, Milliman/MCG, or payer policies.
• Prior employment with insurance carriers, TPAs, or managed care organizations.
• Strong medical terminology, anatomy and physiology knowledge.
• Proficiency with Microsoft Word, Excel, Outlook.

Responsibilities

• Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.
• Ensure clear, evidence-based rationales support recommendations and determinations.
• Follow client instructions and address all questions in reviews.
• Ensure reports contain current references from reputable journals.
• Verify content, format, and professional appearance meet standards.
• Confirm correct board specialty review and proper documentation on case reports.
• Verify reviewer attestation and absence of conflicts of interest.
• Ensure provider credentials and signatures are accurate on final reports.
• Identify inconsistencies and obtain clarifications from peer reviewers.
• Assist in resolving client complaints and QA issues.
• Ensure ERISA and state mandates are followed.
• Provide insights to management on quality, availability and compliance.
• Promote efficient use of resources and participate in training.
• Perform other duties as assigned.

Skills

Peer review

Clinical documentation review

Medical necessity assessments

CMS guidelines

InterQual/Milliman/MCG

Payer policies

Medical terminology

Education

High school diploma or equivalent

2 years clinical or related experience

Tools

Microsoft Word

Outlook

Excel

Internet

Job description

ExamWorks is seeking a Clinical Quality Assurance Coordinator to ensure peer review reports meet high quality and regulatory standards. This role analyzes clinical documentation, ensures evidence-based rationales, and verifies references, credentials, and compliance with client specifications.

You will support resolution of client issues, advise management on quality controls, and participate in training while maintaining confidentiality and accuracy in a 100% remote, EST-based schedule.