Clinical Quality Assurance Coordinator
Company: Examworks
Location: Kenosha
Posted on: April 6, 2021
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Job Description:
Looking to get away from bed-side and stay in the nursing world
while utilizing your clinical background? MES Solutions offers
nurses an ideal work/life balance!We are seeking passionate and
skilled RN's to serve as a Clinical Quality Assurance Nurse
(internally known as Clinical Quality Assurance Coordinator),
reviewing cases and ensuring all necessary information has been
provided and is accurate before sending back to requestor.This
position is 100% remote.We do not offer equipment, so candidate
must provide their own computer, phone and internet access.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.
ESSENTIAL DUTIES AND RESPONSIBILITIES TO PERFORM THIS JOB
SUCCESSFULLY INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING: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(s) 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.Ensures 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.Promote effective and efficient utilization of
company resources.Participate in various educational and or
training activities as required.Perform other duties as
assigned.EDUCATION AND/OR EXPERIENCEAssociates degree requiredRN or
LPN/ LVN licensure requiredA minimum of two years clinical or
related field experience; or equivalent combination of education
and experience requiredKnowledge of the insurance industry
preferably claims management relative to one or more of the
following categories: workers'' compensation, no-fault, liability,
and/or disability preferredQUALIFICATIONS 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.MMust 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.Must be able to stay focused
and concentrate under normal or heavy distractions.Must be able to
work well under pressure and or stressful conditions.Must possess
the ability to manage change, delays, or unexpected events
appropriately.Demonstrates reliability and abides by the company
attendance policy.Must maintain a professional and clean appearance
at all times consistent with company standards.ABOUT US: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/Veteransby Jobble
Keywords: Examworks, Kenosha , Clinical Quality Assurance Coordinator, Healthcare , Kenosha, Wisconsin
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