Remote Clinical Quality Assurance Specialist

TEKsystems•Rockford, IL

10d•$27 - $29•Remote

About The Position

This position is ideal for a nursing professional who enjoys analyzing clinical documentation, collaborating with medical professionals, and helping maintain the highest standards of healthcare quality. As a Clinical Quality Assurance Coordinator, you will be responsible for reviewing clinical reports and ensuring compliance with client requirements, regulatory standards, and company quality expectations.

Requirements

Current, active RN or LPN license required
Strong clinical knowledge and understanding of medical terminology and healthcare documentation
Exceptional attention to detail and analytical skills
Ability to work independently and manage priorities effectively
Strong written and verbal communication skills
Reliable, organized, and self-motivated professional

Nice To Haves

CPC (Certified Professional Coder) certification
Medical coding or healthcare documentation review experience
Prior quality assurance, utilization review, peer review, case management, or clinical compliance experience
Knowledge of ERISA, regulatory compliance, and healthcare quality standards

Responsibilities

Perform comprehensive quality assurance reviews of peer review reports, correspondence, addendums, and supplemental reviews.
Verify that all recommendations and determinations are supported by clear, concise, evidence-based clinical rationale.
Ensure client instructions, specifications, and case questions have been fully addressed.
Review clinical citations and references for accuracy, relevance, and currency.
Ensure reports maintain the highest standards of professionalism, quality, formatting, and presentation.
Verify appropriate physician specialty reviews are completed in accordance with client requirements and state mandates.
Confirm reviewer attestations, provider credentials, signatures, and conflict-of-interest requirements are properly documented.
Identify report inconsistencies and collaborate with peer reviewers to obtain clarifications, corrections, or modifications.
Support the resolution of client concerns and quality assurance issues.
Ensure adherence to federal ERISA regulations, state mandates, and internal compliance standards.
Provide feedback to leadership regarding consultant quality, compliance, and availability.
Participate in training, educational opportunities, and quality improvement initiatives.
Assist with additional projects and duties as assigned.