Clinical Quality Assurance Coordinator

🔥 1 minute ago

🌲 Oregon – Remote

🌲 Oregon – Remote

💵 $40 - $42 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔧 QA Engineer (Quality Assurance)

👻 Ghost score 0%

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ExamWorks

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 2008

🏥 Healthcare

💼 Consulting

⚖️ Legal

Healthcare • Consulting • Legal

ExamWorks is a leading provider of independent medical examinations and peer reviews, specializing in services such as bill reviews, Medicare compliance, and document management. With a robust portfolio that includes agile development and enterprise platform solutions, ExamWorks ensures efficient workflow enhancements and compliance auditing across healthcare sectors. The company supports a network of physicians and offers customized services for the management of medical records and claims, prioritizing reliability for clients in various communities.

📋 Description

• Perform quality utilization review using acquired knowledge and evidence-based guidelines for peer review reports, correspondence, addendums, and supplemental reviews • Work directly with providers to identify level, intensity, and duration of care • Document findings and continue evaluating medical necessity for frequency, intensity, and length of required care • Ensure consistency and quality of reviews meets or exceeds industry standards • Complete quality reviews within required client, federal, state, and URAC-mandated turnaround times • Maintain and apply knowledge of URAC and other 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 quality assurance standards, ERISA, URAC, and other state guidelines • Provide management with insight and direction regarding compliance concerns • Participate in company meetings, training activities, and continuing education requirements • 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 management directions accurately • 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 opportunity • Flexible work from home • Medical, vision, and dental benefits • Paid time off • 401k • Continuing education opportunities