Remote Clinical Quality Assurance Nurse Coordinator

Paycom - ATS; Southfield (MI); Remote; USD 41,000 - 45,000; Full time

Benefits offered by this job

Remote work

Competitive benefits

Paid time off

401k

Job summary

ExamWorks is seeking a Clinical Quality Assurance Coordinator to join our remote team. The role focuses on ensuring peer review reports meet quality standards, regulatory requirements, and client specifications.

The position supports nurses and QA professionals, offering flexible from-home work hours, a 8:30am–5:00pm EST schedule, and opportunities to impact critical reporting accuracy for health plans, TPAs, and managed care organizations.

Qualifications

• Minimum two years of clinical or related field experience.
• Experience in peer review or medical necessity assessments.
• Familiar with CMS guidelines, InterQual, MCG, or payer policies.
• Prior employment with insurance carriers, TPAs, or managed care organizations.
• Strong medical terminology knowledge.
• Must be able to compute rates and percentages and type 40 WPM.

Responsibilities

• Perform quality assurance review of peer review reports and addenda.
• Provide clear evidence-based rationales for recommendations.
• Ensure client instructions are followed and questions addressed.
• Cite current references from reputable journals.
• Ensure reports are high quality and compliant with standards.
• Verify credentials and signatures are accurate on reports.
• Communicate with Peer Reviewer for clarifications when needed.
• Assist in resolution of client complaints and QA issues.
• Adhere to ERISA and state mandates.
• Support management with quality and policy compliance.
• Promote efficient use of company resources.
• Participate in training activities.
• Perform other duties as assigned.

Skills

Peer review experience

Clinical documentation review

CMS guidelines InterQual MCG

Payer policies familiarity

Insurance/TPA experience

Education

High school diploma

Tools

Microsoft Word

Outlook

Excel

Internet

Job description

ExamWorks is seeking a Clinical Quality Assurance Coordinator to join our remote team. The role focuses on ensuring peer review reports meet quality standards, regulatory requirements, and client specifications.

The position supports nurses and QA professionals, offering flexible from-home work hours, a 8:30am–5:00pm EST schedule, and opportunities to impact critical reporting accuracy for health plans, TPAs, and managed care organizations.