Clinical Quality Assurance Coordinator (RN)

Overview Calling All RN's! Are you an RN looking for an exciting new opportunity? MES is on the hunt for a talented Clinical Quality Assurance Coordinator to join our growing team! In this role, you'll dive into medical records, pulling out key details and crafting detailed narrative summaries. Your keen eye for detail will make you an invaluable part of our quality assurance process. Why You'll Love This Role 100% Remote – Work from where you're most comfortable – home! Flexible Hours – Monday-Friday 8:00 am-4:30 pm early shift (3 days), 10:00 am-6:30 pm (1 day) and 12:00 pm-8:30 pm (1 day) ALL ET Great Training – The first 4-6 weeks of training are designed to set you up for success, with a preferred training schedule of 12:00 pm-8:30 pm EST. Essential Duties & Responsibilities Performs quality assurance review of peer review reports, correspondences, addendums or supplemental reviews. Ensures clear, concise, evidence-based rationales are provided in support of all recommendations and/or determinations, and that all client instructions and specifications have been followed. 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 meet the highest quality standards and company guidelines. Ensures 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 only the fact(s) and that no evidence of reviewer conflict of interest exists. Ensures provider credentials and signature are adhered to the final report. Identifies 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, procedures and client specifications. Promotes effective and efficient utilization of company resources. Participates in various educational and training activities as required. Qualifications Education & Experience: High school diploma or equivalent required. A minimum of two years of clinical or related field experience; or an equivalent combination of education and experience preferred. Knowledge: Insurance industry knowledge, preferably claims management in workers' compensation, no-fault, liability or disability preferred. Certificates: LPN/LVN/RN may be required based on business needs. Strong knowledge of medical terminology, anatomy, physiology, medications and laboratory values. Qualified typist with a minimum of 40 WPM. Full understanding of HIPAA regulations and compliance. Computer proficiency: general computer, fax, copier, scanner, telephone, Microsoft Word, Outlook, Excel and internet. Exceptional communication skills, ability to follow instructions accurately, and ability to maintain confidentiality. Self-directed, prioritizing work activities, and working independently under time pressure or stressful conditions. Positive, team-oriented attitude and ability to adapt to change, delays or unexpected events. Compliance with all company policies and procedures in effect. Language & Communication Skills Interpret common correspondence, medical records, and legal documents. Write clearly and edit own work for appropriate spelling and grammar. Respond to inquiries or complaints from customers, physicians, regulatory agencies or community members professionally. Present information effectively in one-on-one or small group settings. Physical Demands Ability to work at a desk up to 8 hours a day or more; operate a computer up to 4 hours; travel to different floors or locations; move throughout the office; occasionally lift, push or pull up to 10 lbs; occasional bending, squatting or twisting. Work Environment Extended hours may be required beyond the regular 8-hour work day; moderate noise level. Equal Opportunity Employer MES is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws. Minorities/Females/Disabled/Veterans. J-18808-Ljbffr