Remote RN: Clinical QA Coordinator

MES Solutions; Norwood (MA); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Remote work (100% from home)

Flexible schedule

Job summary

MES Solutions is seeking a driven Registered Nurse (RN) for a Clinical Quality Assurance Coordinator role. This remote position focuses on peer review quality, regulatory alignment, and client specifications to elevate reporting standards.

Candidates will review reports, provide evidence-based rationales, and ensure accuracy of references and credentials. Strong communication and confidentiality are essential.

Qualifications

• Valid RN license and active nursing practice.
• Minimum two years clinical or related field experience.
• Knowledge of the insurance industry (workers' comp, no-fault, liability, disability).
• Strong knowledge of medical terminology, anatomy & physiology, medications and lab values.
• Proficient with Word, Outlook, Excel; typing 40 WPM and good grammar.

Responsibilities

• Perform QA review of peer review reports and addendums.
• Provide evidence-based rationales for recommendations and determinations.
• Ensure client instructions and specifications are followed and questions addressed.
• Ensure reports include clinical citations from reputable journals.
• Maintain content, format and professional appearance per standards.
• Verify correct board specialty review and documentation.
• Attest to facts and ensure no conflicts of interest.
• Ensure provider credentials and signatures are accurate.
• Identify inconsistencies and obtain clarifications.
• Assist in resolution of client complaints and QA issues.
• Adhere to ERISA and state mandates at all times.
• Provide management with QA insights and policy compliance.
• Promote efficient use of company resources.
• Participate in training activities as required.
• Perform other duties as assigned.

Skills

RN license

Strong communication

Medical terminology

Attention to detail

Independent work

Confidentiality

Education

High school diploma or equivalent

Tools

Microsoft Word

Outlook

Excel

Internet

Job description

MES Solutions is seeking a driven Registered Nurse (RN) for a Clinical Quality Assurance Coordinator role. This remote position focuses on peer review quality, regulatory alignment, and client specifications to elevate reporting standards.

Candidates will review reports, provide evidence-based rationales, and ensure accuracy of references and credentials. Strong communication and confidentiality are essential.