Note: The job is a remote job and is open to candidates in USA. Clay Consulting, LLC is looking for 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 and regulatory standards.
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/LPN nursing license required
- Must be a graduate of an accredited nursing program or related medical experience
- 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
- MES offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental)
- Paid time off
- 401k
Company Overview