Clinical Quality Assurance Coordinator

🕒 August 2

🍂 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

• Ensure Peer Review case reports are of top-notch quality and integrity in alignment with client agreements and regulatory standards. • Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews. • Ensure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations. • Ensure that all client instructions and specifications have been followed and that all questions have been addressed. • Ensure each review is supported by clinical citations and references when applicable. • Ensure the content, format, and professional appearance of reports are compliant with company standards. • Document accurately on the case report in compliance with specifications and mandates. • Contact the Peer Reviewer to obtain clarification, modification or correction as needed for inconsistencies within the report. • Assist in resolution of customer complaints and quality assurance issues as needed.

🎯 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

• Medical insurance • Vision • Dental • Paid time off • 401k