Remote RN: Clinical Quality Assurance Coordinator

AllMed Medical Management; Portland (OR); Remote; USD 70,000 - 95,000; Full time

Benefits offered by this job

Remote work

Medical/vision/dental benefits

Paid time off

401k

Job summary

AllMed is seeking a Clinical Quality Assurance Coordinator to join a 100% remote role supporting Pacific Time operations. You will review and approve care based on evidence-based guidelines, ensuring medical necessity and compliance with URAC, ERISA, and regulatory requirements.

The ideal candidate is a Registered Nurse with strong attention to detail, excellent communication, and the ability to work independently in a fast-paced healthcare environment.

Qualifications

• Must hold and maintain an unencumbered Nursing license.
• UMR or IRO experience.
• Remote work experience
• Strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
• Typing speed of 40 WPM or higher.
• Must understand HIPAA regulations and compliance.
• Proficient with MS Word, Outlook, Excel, and Internet.
• Excellent communication skills.
• Ability to work independently and manage time effectively.
• Maintain confidentiality and promote teamwork.
• Ability to adapt to change and handle pressure.

Responsibilities

• Perform quality utilization review using evidences-based guidelines for reports, addendums, and reviews.
• Collaborate with providers to determine level, intensity and duration of care.
• Document findings and assess medical necessity for frequency, intensity and length of care.
• Ensure reviews meet industry standards and URAC/regulatory requirements.
• Meet client, federal and state turnaround times for quality reviews.
• Maintain utilization review records in the database.
• Coordinate with Customer Service to ensure timely determination letters.
• Assist in resolution of client complaints and QA issues.
• Provide compliance insights to management.
• Participate in meetings and continuing education requirements.
• Perform other duties as assigned.

Skills

RN licensure

Remote work experience

Medical terminology

HIPAA compliance

Typing 40 WPM

Communication skills

Time management

Attention to detail

Tools

Microsoft Word

Outlook

Excel

Internet

Job description

AllMed is seeking a Clinical Quality Assurance Coordinator to join a 100% remote role supporting Pacific Time operations. You will review and approve care based on evidence-based guidelines, ensuring medical necessity and compliance with URAC, ERISA, and regulatory requirements.

The ideal candidate is a Registered Nurse with strong attention to detail, excellent communication, and the ability to work independently in a fast-paced healthcare environment.