LPN - 100% Remote
About The Position
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.
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.
Benefits
- Medical, dental & vision
- Critical Illness, Accident, and Hospital
- 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
- Life Insurance (Voluntary Life & AD&D for the employee and dependents)
- Short and long-term disability
- Health Spending Account (HSA)
- Transportation benefits
- Employee Assistance Program
- Time Off/Leave (PTO, Vacation or Sick Leave)
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
