Remote Clinical Quality Assurance Coordinator - RN/LPN

MES Solutions; Winslows (MA); Remote; USD 70,000 - 100,000; Full time

Benefits offered by this job

Medical benefits

Vision benefits

Dental benefits

401k

Paid time off

Job summary

MES Solutions is seeking a self-driven RN or LPN to join as Clinical Quality Assurance Coordinator, delivering top-notch peer review reports with evidence-based rationales. This 100% remote role follows client agreements, regulatory standards, and state/federal mandates.

You'll review reports, ensure proper citations, maintain professional appearance, and support management with quality and compliance insights while working a Monday–Friday schedule. Equal opportunity employer.

Qualifications

• Active RN or LPN license required.
• Graduate of an accredited nursing program; bachelor's degree preferred.
• A minimum of two years clinical or related field experience.
• Strong knowledge of medical terminology, anatomy and physiology.
• Must be a qualified typist with a minimum of 40 WPM.
• Proficiency with Microsoft Word, Outlook, and Excel.

Responsibilities

• Performs quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.
• Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
• Ensures client instructions and specifications have been followed and questions addressed.
• Ensures reports include clinical citations from reputable journals.
• Maintains quality and professional appearance of reports in compliance with standards.
• Verifies appropriate board specialty review and documentation per client specs/state mandates.
• Verifies reviewer has attested to only facts, with no conflicts of interest.
• Ensures provider credentials and signature are properly documented.
• Identifies inconsistencies and coordinates with Peer Reviewer for clarification or correction.
• Assists in resolution of customer complaints and quality issues.
• Ensures ERISA and state mandates are adhered to.
• Provides management with quality/compliance insights and resource utilization guidance.

Job description

MES Solutions is seeking a self-driven RN or LPN to join as Clinical Quality Assurance Coordinator, delivering top-notch peer review reports with evidence-based rationales. This 100% remote role follows client agreements, regulatory standards, and state/federal mandates.

You'll review reports, ensure proper citations, maintain professional appearance, and support management with quality and compliance insights while working a Monday–Friday schedule. Equal opportunity employer.