Clinical Quality Assurance Coordinator

Description

Ready for a Rewarding Career that Fits Your Lifestyle?

Imagine a job where you can keep your clinical skills sharp
, tackle exciting challenges, AND work from the comfort of your own home. Sounds like the perfect mix, right?

MES is looking for a self-driven, high-performing Registered Nurse (RN) to join our dynamic team as a Clinical Quality Assurance Coordinator
. In this role, you'll ensure our Peer Review case reports are nothing short of exceptional-delivering top-notch quality and integrity, all while staying fully aligned with client agreements
, regulatory standards
, and state and federal mandates
.

The position is 100% remote with a schedule of Monday through Friday:

• three days 12-8:30PM EST,
• two days 8-4:30pm EST or 9-5:30
  
  EST

• 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.

If you're ready to make a real impact in healthcare, all while enjoying the flexibility of working remotely, we want to hear from you!

• Active RN 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.

MES Solutions is a premier provider of independent medical examination and peer review services to the insurance, corporate, legal, and government sectors. Members of our…