Clinical Quality Assurance Coordinator

🔥 18 hours ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $27 - $31 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔧 QA Engineer (Quality Assurance)

👻 Ghost score 0%

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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 reviews of peer review reports, correspondence, addendums, and supplemental reviews • Ensure clear, concise, evidence-based rationales support recommendations and determinations • Verify client instructions, specifications, questions, clinical citations, and current reputable references are followed • Ensure report content, format, appearance, and compliance meet company standards • Confirm appropriate board specialty review and accurate documentation • Verify peer reviewer attestations, absence of conflicts of interest, provider credentials, and signatures • Identify report inconsistencies and contact peer reviewers for clarification or corrections • Assist with customer complaints and quality assurance issues • Ensure compliance with federal ERISA and state mandates • Provide management insight on consultant quality, availability, and compliance • Promote efficient use of company resources • Participate in required educational and training activities • Perform other assigned duties

🎯 Requirements

• Active RN/LPN nursing license required • Graduate of an accredited nursing program or related medical experience • Minimum of two years clinical or related field experience, or equivalent combination of education and experience • Strong knowledge of medical terminology, anatomy and physiology, medications, and laboratory values • Ability to compute using whole numbers and decimals, including rates and percentages • Qualified typist with a minimum of 40 W.P.M. • Ability to operate a computer, fax, copier, scanner, and telephone • Knowledge of Microsoft Word, Outlook, Excel, and the Internet • Excellent English usage, grammar, punctuation, and style • Ability to follow instructions and respond accurately to management directions • Accuracy and thoroughness • Exceptional communication skills • Ability to work independently, prioritize work, and use time efficiently • Ability to maintain confidentiality

🏖️ Benefits

• Fully remote work • Medical, vision, and dental benefits • Paid time off • 401k • Competitive benefits • Educational and training activities

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