MES Solutions · 4 weeks ago
Clinical Quality Assurance Coordinator
United States
Full-time
Remote
Entry, Mid Level
2+ years expMES Solutions is a premier provider of independent medical examination and peer review services. They are seeking a Clinical Quality Assurance Coordinator who will ensure the quality and integrity of peer review case reports while adhering to client agreements and regulatory standards.
GovernmentHealth CareMedical
Responsibilities
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
Qualification
Required
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
Preferred
Bachelor's degree preferred
Benefits
Medical
Vision
Dental
Paid time off
401k
Company
MES Solutions
MES Solutions and MES Peer Review Services provide physicians with expertise in conducting Independent Medical Examinations
201-500 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase