Clinical Quality Assurance Coordinator

🕒 July 24

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $30 - $31 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔧 QA Engineer (Quality Assurance)

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MES Solutions

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1978

🏥 Healthcare

⚖️ Legal

💼 Consulting

Healthcare • Legal • Consulting

MES Solutions is a provider of independent medical evaluation and peer review services for the claims and risk-management community. The company coordinates Independent Medical Examinations (IMEs), record retrieval and record reviews, peer review services, physician credentialing, and fitness-for-duty and disability assessment support. Its clients include insurers, third-party administrators, self-insured employers, government agencies, and attorneys across auto, disability, liability, workers' compensation, and group health markets, and it emphasizes compliance with HIPAA, HITECH, and HITRUST.

📋 Description

• Perform 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

🎯 Requirements

• 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 able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages • 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 • Demonstrates accuracy and thoroughness • Looks for ways to improve and promote quality and monitors own work to ensure quality is met • Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed • Must be able to work independently, prioritize work activities and use time efficiently • Must be able to maintain confidentiality.

🏖️ Benefits

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