[Remote] Clinical Quality Assurance Coordinator (32357)

Note: The job is a remote job and is open to candidates in USA. MES Solutions is a premier provider of independent medical examination and peer review services to various sectors. They are seeking a Clinical Quality Assurance Coordinator who will ensure that Peer Review case reports meet high standards of quality and integrity while adhering to client expectations and regulatory requirements.

Responsibilities

• 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

Skills

• High school diploma or equivalent required
• Active nursing license
• A minimum of two years clinical or related 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 qualified typist with a minimum of 40 W.P.M
• 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

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
• MES offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k

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