Remote Clinical Quality Assurance Coordinator (RN)

MES Solutions; United States; On-site; USD 55,000 - 85,000; Full time

Benefits offered by this job

100% Remote

Flexible Hours

Great Training

Employee-first culture

Benefits and growth opportunities

Job summary

MES is seeking a Clinical Quality Assurance Coordinator (RN) for a 100% remote position. You will review medical records, craft narrative summaries, and ensure QA standards. The role requires attention to detail and familiarity with healthcare documentation and HIPAA.

Responsibilities include conducting quality reviews, citing clinical references, and ensuring reports meet client and regulatory requirements. Two years of clinical experience and accurate typing are preferred.

Qualifications

• High school diploma or equivalent required.
• 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.

Responsibilities

• Performs quality assurance reviews of peer review reports and supporting documentation with evidence-based rationales.
• Ensures client instructions and specifications are followed and questions addressed.
• Cites clinical references from reputable journals and ensures currency of references.
• Ensures reports are professional, accurate, and compliant with company standards.
• Confirms board specialty review aligns with client specifications and mandates.
• Verifies peer reviewer attests to facts with no conflicts of interest.
• Ensures provider credentials and signatures are properly reflected in final reports.
• Identifies inconsistencies and coordinates with Peer Reviewer for corrections.
• Assists in resolution of customer complaints and QA issues.
• Adheres to ERISA and state mandates at all times.
• Provides management with insights on consultant quality and compliance.
• Promotes efficient use of company resources.
• Participates in educational/training activities.

Skills

Clinical QA

Medical terminology

Anatomy & physiology

HIPAA compliance

Typing 40 WPM

Microsoft Word

Microsoft Excel

Outlook

Internet

Education

High school diploma or equivalent

LPN/LVN/RN license (may be required)

Tools

Microsoft Word

Microsoft Outlook

Microsoft Excel

Internet

Job description

MES is seeking a Clinical Quality Assurance Coordinator (RN) for a 100% remote position. You will review medical records, craft narrative summaries, and ensure QA standards. The role requires attention to detail and familiarity with healthcare documentation and HIPAA.

Responsibilities include conducting quality reviews, citing clinical references, and ensuring reports meet client and regulatory requirements. Two years of clinical experience and accurate typing are preferred.