Clinical Quality Assurance Nurse Auditor

🔥 6 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $34 - $35 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔧 QA Engineer (Quality Assurance)

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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

• Review and refine critical medical reports, chronologies, and provider bills to ensure flawless clinical accuracy and professional presentation. • Verify that every clinical determination is backed by robust, current citations from reputable medical journals. • Collaborate directly with reviewing physicians to clarify complex case details and resolve inconsistencies. • Ensure full alignment with federal ERISA regulations, state mandates, and client specifications, while strictly verifying that no conflicts of interest exist. • Help resolve client quality questions, recover missing medical data, and provide management with strategic insights on consultant performance.

🎯 Requirements

• Active Registered Nurse (RN) license with strong clinical judgment • Bachelor/Associate degree in nursing or related field; or minimum five years related experience; or equivalent combination of education and experience • Experience with medical terminology, medications, medical specialties and treatment protocols required • Experience in the insurance industry preferred

🏖️ Benefits

• Health insurance • Professional development opportunities