Clinical Quality Assurance Coordinator

🕒 Agosto 2

🍂 Massachusetts – Remoto

🍂 Massachusetts – Remote

💵 $30 - $31 / hora

⏰ Tempo Integral

🟢 Júnior

🟡 Pleno

🔧 Engenheiro de QA (Qualidade de Software)

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ExamWorks

SiteLinkedInTodas as Vagas

5001 - 10000 funcionários

Fundada em 2008

🏥 Saúde

💼 Consultoria

⚖️ Jurídico

Healthcare • Consulting • Legal

A ExamWorks é uma empresa de serviços de saúde que oferece exames médicos independentes (EMIs), revisões de pares e registros médicos, revisão de contas, serviços de conformidade e pagador secundário do Medicare, além de recuperação de registros médicos. Ela opera uma plataforma tecnológica corporativa e nuvem privada com portais, melhorias de fluxo de trabalho e ferramentas de gestão de credenciais/documentos para apoiar seguradoras, empregadores e clientes jurídicos. A ExamWorks também mantém uma rede profissional de médicos e centros de atendimento, oferece serviços de auditoria e conformidade e personaliza seu portfólio de serviços para fluxos de trabalho de revisão de sinistros e avaliação de deficiência.

Descrição

• Performs quality assurance review of peer review reports, correspondences, addendums or supplemental reviews. • Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations. • Ensures that all client instructions and specifications have been followed and that all questions have been addressed. • 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 are of the highest quality and in compliance with company standards. • Ensure that 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 to only the fact(s) and that no evidence of reviewer conflict of interest exists. • Ensures the provider credentials and signature are adhered to the final report. • Identifies any 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 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.

🎯 Requisitos

• Active RN nursing license required. • Must be a graduate of an accredited nursing program or related medical experience; bachelor's degree preferred. • A minimum of two years clinical or related field experience; or equivalent combination of education and experience. • Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values. • Must be a qualified typist with a minimum of 40 W.P.M. • Must be able to operate a general computer, fax, copier, scanner, and telephone. • Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet. • Must possess excellent skills in English usage, grammar, punctuation and style. • Ability to follow instructions and respond to upper managements’ directions accurately. • Must be able to maintain confidentiality.

🏖️ Benefícios

• Health insurance • 401(k) matching • Paid time off