Clinical Quality Assurance Coordinator (31779)
Ready to Take Your Nursing Career to the Next Level - Without Leaving Home?
Picture this: You’re using your clinical expertise, solving meaningful challenges, and making a real impact -all while working from the comfort of your own home. Sounds like the perfect balance, right?
MCMC is on the lookout for a motivated, detail-driven Nurse (LPN, LVN, or RN) to join our team as a Clinical Quality Assurance Coordinator. In this role, you’ll be the guardian of excellence - ensuring every Peer Review case report meets the highest standards of quality, integrity, and compliance with client agreements, regulatory guidelines, and state and federal mandates.
What’s in it for you?
- 100% remote work!
- A consistent schedule: Monday–Friday, 11:30 AM–8:00 PM EST
- Occasional holiday and weekend coverage for variety
- A chance to keep your clinical skills sharp while exploring a new side of healthcare
Responsibilities may include:
- Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.
- Ensure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
- Ensure that all client instructions and specifications have been followed and that all questions have been addressed.
- Ensure each review is supported by clinical citations and references when applicable and verifies that all references cited are current 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 within 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 all federal ERISA and state mandates are adhered to at all times.
- Provide insight and direction to management on consultant quality, availability and compliance with all 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.
- Perform other duties as assigned.
If you’re self-driven, thrive on precision, and love the idea of combining flexibility with purpose, we want to meet you.