[Remote] Clinical Quality Assurance Coordinator (32345)

Note: The job is a remote job and is open to candidates in USA. Clay Consulting, LLC is seeking a self-driven, high-performing RN or LPN to join their dynamic team as a Clinical Quality Assurance Coordinator. In this role, you will ensure exceptional quality in Peer Review case reports while adhering to client agreements, regulatory standards, and state and federal mandates.

Responsibilities

• Performs quality assurance review of peer review reports, correspondences, addendums or supplemental reviews
• Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations
• Ensures that all client instructions and specifications have been followed and that all questions have been addressed
• Ensures 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
• Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards
• Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report
• Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists
• Ensures the provider credentials and signature are adhered to the final report
• Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed
• Assists in resolution of customer complaints and quality assurance issues as needed
• Ensures all federal ERISA and/or state mandates are adhered to at all times
• Provides 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

Skills

• Active RN or LPN nursing license required
• Must be a graduate of an accredited nursing program or related medical experience; bachelor's degree preferred
• A minimum of two years clinical or related field experience; or equivalent combination of education and experience
• Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values
• Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages
• Must be a qualified typist with a minimum of 40 W.P.M
• Must be able to operate a general computer, fax, copier, scanner, and telephone
• Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, 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 able to work independently, prioritize work activities and use time efficiently
• Must be able to maintain confidentiality
• Bachelor's degree preferred

Benefits

• Competitive benefits (medical, vision, dental)
• Paid time off
• 401k

Company Overview