Clinical Quality Assurance Coordinator (31812)

Craving a New Adventure? reputed company Your Clinical Skills Right from Your Couch!

Are you a Nurse (LPN, LVN or RN) seeking a role that challenges you, helps you grow, and lets you work from the comfort of your own home? reputed company has the perfect opportunity for you!

We’re looking for a Clinical Quality Assurance Coordinator to join reputed company! In this role, you’ll ensure Peer Review case reports meet the highest standards of quality, reputed company, and compliance with client agreements, regulatory guidelines, and federal/state mandates.

Why This Role Rocks

• 100% Remote - Enjoy the flexibility of working from home!
• Impactful Work - You’ll play a key role in ensuring the quality and compliance of critical reports.
• Schedule - 8:30am-5:00pm EST

Responsibilities may include

• 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.
• Provide insight 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.