Remote RN: Clinical Quality & Utilization Coordinator

AllMed Healthcare Management; Portland (OR); On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Medical, vision, dental

401k

Paid time off

Job summary

AllMed is seeking a Clinical Quality Assurance Coordinator (RN) to lead quality utilization reviews and ensure medical necessity in accordance with evidence-based guidelines.

The role is 100% remote, requiring a strong knowledge of HIPAA, URAC standards, and regulatory compliance. You will interact with providers, document findings, and support management on compliance concerns while maintaining strict turnaround times.

Qualifications

• Must hold and maintain an unencumbered Nursing license.
• Remote work experience preferred in healthcare quality assurance.
• Familiarity with URAC and federal/state regulations.

Responsibilities

• Perform quality utilization review using evidence-based guidelines for peer reviews and correspondence.
• Collaborate with providers to determine level, intensity and duration of care.
• Document findings and evaluate medical necessity for care frequency and length.
• Ensure reviews meet industry standards and client/URAC turnaround times.
• Maintain URAC knowledge and ensure compliance with regulations.
• Assist in addressing client complaints and QA issues as needed.

Skills

Typing 40 WPM

HIPAA knowledge

Medical terminology

Strong communication

URAC familiarity

Education

Registered Nurse license

Tools

Microsoft Word

Excel

Outlook

Job description

AllMed is seeking a Clinical Quality Assurance Coordinator (RN) to lead quality utilization reviews and ensure medical necessity in accordance with evidence-based guidelines.

The role is 100% remote, requiring a strong knowledge of HIPAA, URAC standards, and regulatory compliance. You will interact with providers, document findings, and support management on compliance concerns while maintaining strict turnaround times.