MES Solutions is seeking a Registered Nurse to join the team as a Clinical Quality Assurance Coordinator. This position will be 100% REMOTE.
The schedule for this position will be Tuesday - Saturday 40 hours per week. 2 days will be 12 - 8:30 EST and 3 days will be 7 - 3:30 or 8 - 4:30 EST.
The Clinical Quality Assurance Coordinator is responsible to ensure Peer Review case reports are of the highest quality and integrity and in full compliance with client contractual agreement, regulatory agency standards and/or federal and state mandates. This position is required to handle quality assurance questions and provide overall support to the Quality Assurance Department.
Performs quality assurance review of peer review reports, correspondences, addendums or supplemental reviews
Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations
Ensures that all client instructions and specifications have been followed and that all questions have been addressed
Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications
Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards
Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report
Verifies that the peer reviewer has attested to only the fact and that no evidence of reviewer conflict of interest exists
Ensures the provider credentials and signature are adhered to the final report
Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed
Assists in resolution of customer complaints and quality assurance issues as needed
nsures all federal ERISA and/or state mandates are adhered to at all times
Provides insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications
Associate's degree required
RN licensure required
2+ years clinical or related field experience; or equivalent combination of education and experience required
Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability preferred
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 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
Must be able to demonstrate and promote a positive team -oriented environment
WHO WE ARE
MES Solutions is a premier provider of independent medical examination and peer review services to the insurance, corporate, legal, and government sectors. Members of our credentialed medical panel conduct physical examinations or medical record reviews, delivering reports that assist clients in the resolution of automotive, disability, liability, and workers' compensation claims. MES has been providing services nationally since 1978 in accordance with the industry's highest standards of operating excellence and regulatory compliance.
MES is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.
Equal Opportunity Employer - Minorities/Females/Disabled/Veterans
Posted Date : 2022-05-07
Job type : Full Time