Remote Clinical Quality Assurance Specialist

MES Solutions; Norwood (MA); Hybrid; USD 37,000 - 43,000; Full time

Benefits offered by this job

Medical benefits

401k

Paid time off

Job summary

MES Solutions seeks a Clinical Quality Assurance Coordinator (RN or LPN) to review peer review reports, ensure accuracy, evidence-based rationales, and alignment with client specifications and regulatory standards.

The position is fully remote, Monday–Friday 12:00 pm–8:30 pm EST, with occasional weekends. Strong clinical knowledge, attention to detail, and proficiency in Word/Excel are essential. MES has provided nationwide services since 1978.

Qualifications

• Active RN or LPN nursing license required.
• Graduate of an accredited nursing program; bachelor's degree preferred.
• Minimum two years clinical or related field experience; related medical experience acceptable.

Responsibilities

• Perform quality assurance review of peer review reports, correspondences, addendums, or supplemental reviews.
• Ensure evidence-based rationales are provided for all recommendations/determinations.
• Verify client instructions and specifications are followed; address all questions.
• Ensure reports include clinical citations from reputable journals.
• Identify inconsistencies and obtain clarification from Peer Reviewer.
• Assist in resolution of customer complaints and QA issues as needed.
• Ensure compliance with ERISA/state mandates and company policies.

Skills

RN license

LPN license

Quality assurance

Peer review

Medical terminology

Clinical experience

40 WPM typing

MS Word

Excel

Education

RN or LPN nursing license

Bachelor's degree preferred

Tools

Microsoft Word

Outlook

Excel

Internet

Job description

MES Solutions seeks a Clinical Quality Assurance Coordinator (RN or LPN) to review peer review reports, ensure accuracy, evidence-based rationales, and alignment with client specifications and regulatory standards.

The position is fully remote, Monday–Friday 12:00 pm–8:30 pm EST, with occasional weekends. Strong clinical knowledge, attention to detail, and proficiency in Word/Excel are essential. MES has provided nationwide services since 1978.