Clinical Quality Assurance Specialist (RN/LPN)
About The Position
The Clinical Quality Assurance Specialist reviews clinical reports and documentation to ensure accuracy, quality, and compliance with client requirements and regulatory standards. The role is intended for an RN, LPN, or professional with equivalent clinical documentation experience who is comfortable reviewing records, collaborating with healthcare professionals, and supporting evidence-based clinical review processes. This is a fully remote, contract-to-hire position based out of Houston, Texas. The position pays $26.50–$28.50 per hour. Training follows a Monday–Friday schedule; at conversion, the employer will consider four 10-hour days per week. The assigned shift falls between 6:00 AM and 7:00 PM CST, with three consecutive days off each week for the four-day schedule. Company-provided equipment includes a laptop, monitor, keyboard, mouse, and phone. Benefits for eligible employees may include medical, dental, and vision coverage; critical illness, accident, and hospital coverage; a 401(k) retirement plan with pre-tax and Roth contributions; life insurance; short- and long-term disability; a health spending account; transportation benefits; an employee assistance program; and time off or leave, including PTO, vacation, or sick leave. Eligibility and availability depend on factors including job classification and length of employment, and plan terms may apply.
Requirements
- Active RN or LPN background, or equivalent clinical documentation experience.
- Experience reviewing clinical documentation, medical records, or healthcare reports.
- Strong professional writing and editing skills.
- Ability to manage deadlines and maintain a high level of accuracy.
- Strong attention to detail and critical-thinking skills.
- Ability to work independently in a remote environment.
- Reliable and self-motivated work style.
Nice To Haves
- Experience in healthcare quality assurance, utilization review, compliance, or peer review environments.
- Familiarity with regulatory and healthcare documentation standards.
- Experience evaluating clinical reports for accuracy and completeness.
Responsibilities
- Perform quality assurance reviews of peer review reports, correspondence, addendums, and supplemental reviews.
- Ensure recommendations and determinations are supported by clear, evidence-based rationales.
- Verify adherence to client specifications, regulatory guidelines, and contractual requirements.
- Review clinical citations and references for relevance, accuracy, and credibility.
- Ensure reports meet quality, formatting, and professional standards.
- Confirm appropriate clinical specialty reviews are completed and accurately documented.
- Identify discrepancies, omissions, or inconsistencies and coordinate corrections when needed.
- Assist with quality assurance concerns, compliance questions, and issue resolution.
- Support adherence to federal and state healthcare regulations.
- Collaborate with internal teams to maintain quality standards.
- Participate in ongoing training and professional development activities.
Benefits
- Company-provided equipment: laptop, monitor, keyboard, mouse, and phone.
- Medical, dental, and vision coverage, if eligible.
- Critical illness, accident, and hospital coverage, if eligible.
- 401(k) retirement plan with pre-tax and Roth post-tax contributions, if eligible.
- Voluntary life insurance and AD&D coverage for employees and dependents, if eligible.
- Short- and long-term disability, if eligible.
- Health Spending Account (HSA), if eligible.
- Transportation benefits, if eligible.
- Employee Assistance Program, if eligible.
- Time off or leave, including PTO, vacation, or sick leave, if eligible.
- Four-day work week at conversion, with three consecutive days off each week.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
