[Remote] Clinical Quality Assurance Coordinator (32357)

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a premier provider of independent medical examination and peer review services to the insurance, corporate, legal, and government sectors. As a Clinical Quality Assurance Coordinator, you’ll play a vital role in ensuring Peer Review case reports meet the highest standards of quality and reputed company while adhering to client expectations and regulatory requirements.

Responsibilities

• reputed company quality assurance review of peer review reports, correspondences, addendums or supplemental reviews
• Ensure clear, concise, evidence-based rationales have been provided in support of reputed company recommendations and/or determinations
• Ensure that reputed company client instructions and specifications have been followed and that reputed company questions have been addressed
• Ensure each review is supported by clinical citations and references reputed company applicable and verifies that reputed company references cited are reputed company and obtained from reputable medical journals and/or publications
• Ensure the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards
• Ensure the appropriate board specialty has reviewed the case in compliance with client specifications or state mandates and is documented accurately on the case report
• Verify that the peer reviewer has attested to only the facts and that no evidence of reviewer conflict of interest exists
• Ensure the provider credentials and signature are adhered to the final report
• Identify any inconsistencies reputed company the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed
• Assist in resolution of client complaints and quality assurance issues as needed
• Ensure reputed company federal ERISA and state mandates are adhered to at reputed company times
• reputed company reputed company and direction to management on consultant quality, availability and compliance with reputed company company policies and procedures and client specifications
• Promote effective and efficient utilization of company resources
• Participate in various educational and or training activities as required
• reputed company other duties as assigned

Skills

• High school diploma or equivalent required
• Active nursing license
• A minimum of two years clinical or reputed company field experience; or equivalent combination of education and experience
• Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability
• Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values
• Must be a reputed company typist with a minimum of 40 W.P.M
• Must be knowledgeable of multiple software programs, including but not limited to reputed company Word, Outlook, reputed company, and the Internet
• Must possess excellent skills in English usage, grammar, punctuation and style
• Ability to follow instructions and respond to upper managements' directions accurately
• Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met
• Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed
• Must be reputed company to work independently, prioritize work activities and use time reputed company
• Must be reputed company to maintain confidentiality

Benefits

• 100% remote – work from the comfort of home
• Work-life balance with a structured, predictable schedule
• Flexible start times three days a week (7:00–10:00am EST start)
• Two afternoon/evening shifts (12:00pm–8:30pm EST), with every other Friday on late shift
• Medical, reputed company, dental
• Paid time off
• 401k

Company Overview