Clinical Quality Assurance Specialist

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $26 - $28 / hour

⏳ Contract/Temporary

🟡 Mid-level

🟠 Senior

🔧 QA Engineer (Quality Assurance)

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TEKsystems

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1983

💼 Consulting

🎯 Recruiter

🏢 Enterprise

Consulting • Recruitment • Enterprise

TEKsystems is a global IT and business services firm that provides technology consulting, talent solutions, managed services and workforce recruitment to enterprise clients. The company delivers cloud, digital and data services (including AI/ML and automation), application innovation, Agile/DevOps transformation, technology operations and digital experience work, and operates large-scale talent and managed service programs. TEKsystems works across industries (financial services, healthcare, public sector, telecommunications, retail/manufacturing, energy and more), maintains technology partnerships with major cloud and software providers, and reports more than $7B in annual revenue and 100+ locations worldwide.

📋 Description

• Perform comprehensive quality assurance reviews of peer review reports, correspondence, addendums, and supplemental reviews • Verify recommendations and determinations are supported by clear, concise, evidence-based clinical rationale • Ensure client instructions, specifications, and case questions are fully addressed • Review clinical citations and references for accuracy, relevance, and currency • Ensure reports meet standards for professionalism, quality, formatting, and presentation • Verify appropriate physician specialty reviews are completed according to client requirements and state mandates • Confirm reviewer attestations, provider credentials, signatures, and conflict-of-interest requirements are documented • Identify report inconsistencies and collaborate with peer reviewers on clarifications, corrections, or modifications • Support resolution of client concerns and quality assurance issues • Ensure adherence to federal ERISA regulations, state mandates, and internal compliance standards • Provide leadership feedback regarding consultant quality, compliance, and availability • Participate in training, educational opportunities, and quality improvement initiatives • Assist with additional projects and duties as assigned

🎯 Requirements

• Current, active RN or LPN license required • Strong clinical knowledge and understanding of medical terminology and healthcare documentation • Exceptional attention to detail and analytical skills • Ability to work independently and manage priorities effectively • Strong written and verbal communication skills • Reliable, organized, and self-motivated professional • CPC certification preferred • Medical coding or healthcare documentation review experience preferred • Prior quality assurance, utilization review, peer review, case management, or clinical compliance experience preferred • Knowledge of ERISA, regulatory compliance, and healthcare quality standards preferred • Entry-level to early-career experience level • Contract-to-hire position based out of Rockford, Illinois

🏖️ Benefits

• Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave) • Professional growth and development opportunities • Collaborative and mission-driven healthcare team • Non-bedside role • Exposure to quality assurance and clinical compliance processes • Valuable experience in peer review and healthcare quality management