Remote RN: Clinical Quality Assurance Lead

AllMed Healthcare Management; Portland (OR); Remote; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical, Vision, Dental

Paid time off

401k

Job summary

AllMed Healthcare Management is seeking a Clinical Quality Assurance Coordinator. The role supports quality utilization reviews, ensuring medical necessity and adherence to evidence-based guidelines.

This remote position supports Pacific Time operations with a Sunday-Thursday schedule, offering a flexible home-based work environment. The ideal candidate is a detail-oriented RN with HIPAA knowledge, strong medical terminology, and exceptional communication skills.

Qualifications

• RN license required.
• Strong knowledge of HIPAA regulations and compliance.
• Excellent medical terminology and anatomy knowledge.
• Ability to work independently and manage time effectively.

Responsibilities

• Perform quality utilization review using evidence-based guidelines for peer reviews and addendums.
• Collaborate with providers to identify level, intensity, and duration of care.
• Document findings and evaluate medical necessity for frequency and length of care.
• Ensure reviews meet URAC, ERISA, and client requirements within turnaround times.
• Maintain URAC/regulatory knowledge and accurate URA C records.
• Direct customer service to ensure timely delivery of determination letters.
• Assist in resolving client complaints and quality issues as needed.
• Provide management with insights on compliance concerns and policy adherence.
• Participate in meetings and ongoing training; support continuous education.

Skills

Attention to detail

Quality assurance

HIPAA knowledge

Medical terminology

Communication skills

Independent worker

Education

RN license

Tools

Microsoft Word

Outlook

Excel

Internet

Job description

AllMed Healthcare Management is seeking a Clinical Quality Assurance Coordinator. The role supports quality utilization reviews, ensuring medical necessity and adherence to evidence-based guidelines.

This remote position supports Pacific Time operations with a Sunday-Thursday schedule, offering a flexible home-based work environment. The ideal candidate is a detail-oriented RN with HIPAA knowledge, strong medical terminology, and exceptional communication skills.