Clinical Quality Assurance Coordinator

Job not on LinkedIn

🔥 14 hours ago

🌲 Oregon – Remote

🌲 Oregon – Remote

💵 $38 - $41 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔧 QA Engineer (Quality Assurance)

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

AllMed Healthcare Management

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 1995

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

Consulting • Logistics • Healthcare Insurance

AllMed Healthcare Management is a company that focuses on providing healthcare management solutions. They offer client and reviewer portals to facilitate seamless interactions within their healthcare services, ensuring efficient communication and support for users. AllMed is dedicated to improving healthcare processes and enhancing user experience through their technology-driven platforms.

📋 Description

• Perform quality utilization reviews using acquired knowledge and evidence-based guidelines • Review and approve care based on medical necessity and appropriateness • Prepare and review peer review reports, correspondence, addendums, and supplemental reviews • Work directly with providers to identify level, intensity, and duration of care • Document findings and evaluate medical necessity for frequency, intensity, and length of care • Ensure review consistency and quality meets or exceeds industry standards • Complete quality reviews within client, federal, state, and URAC-mandated turnaround times • Maintain and apply knowledge of URAC and state and federal regulatory requirements • Maintain accurate utilization review records in the appropriate database • Direct Customer Service Representatives to ensure timely delivery of determination letters • Assist with client complaints and quality assurance issues • Ensure adherence to federal ERISA, URAC, and other state guidelines • Provide management with insight and direction on compliance concerns • Participate in company meetings, training activities, and continuing education • Perform other assigned duties

🎯 Requirements

• Must hold and maintain an unencumbered Nursing license • UMR or IRO experience • Remote work experience • Strong knowledge of medical terminology, anatomy and physiology, medications, and laboratory values • Qualified typist with a minimum of 40 W.P.M. • Full understanding of HIPAA regulations and compliance • Ability to operate a computer, fax, copier, scanner, and telephone • Knowledge of Microsoft Word, Outlook, Excel, and the Internet • Exceptional communication skills • Ability to follow instructions and respond accurately to upper management directions • Accuracy and thoroughness • Ability to work independently, prioritize work activities, and use time efficiently • Ability to maintain confidentiality • Ability to work well under pressure or stressful conditions • Ability to manage change, delays, or unexpected events appropriately • Ability to follow company policies and procedures

🏖️ Benefits

• 100% remote work from home • Flexible work arrangement • Medical, vision, and dental benefits • Paid time off • 401(k) • Continuing education requirements

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume