Clinical Quality Assurance Coordinator (32101)

ExamWorks•Rockford Township, IL

2d•Remote

About The Position

ExamWorks is seeking a Clinical Quality Assurance Coordinator, a 100% remote role for nurses (LPN, LVN, or RN), to ensure Peer Review case reports meet the highest standards of quality, integrity, and compliance with client agreements, regulatory guidelines, and federal/state mandates. This role offers the flexibility of working from home and impactful work in ensuring the quality and compliance of critical reports.

Requirements

Strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages.
Qualified typist with a minimum of 40 W.P.M preferred.
Ability to operate a general computer, fax, copier, scanner, and telephone.
Knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
Excellent skills in English usage, grammar, punctuation and style.
Ability to follow instructions and respond to upper management’s directions accurately.
Demonstrate accuracy and thoroughness.
Look for ways to improve and promote quality and monitors own work to ensure quality is met.
Exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
Ability to work independently, prioritize work activities and use time efficiently.
Ability to maintain confidentiality.
Ability to demonstrate and promote a positive team -oriented environment.

Nice To Haves

Nurse (LPN, LVN or RN)

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.