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MCMC Services, LLC · 16 hours ago

Clinical Quality Assurance Coordinator

United States

Full-time

Remote

Mid Level

MCMC Services, LLC is seeking a motivated and detail-driven Nurse to join their team as a Clinical Quality Assurance Coordinator. In this role, you will ensure that peer review case reports meet the highest standards of quality, integrity, and compliance with various regulations and client agreements while working remotely.

Health CareHospital

Responsibilities

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 and verifies that all references cited are current and obtained from reputable medical journals and/or publications

Ensure the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards

Ensure the appropriate board specialty has reviewed the case in compliance with client specifications or state mandates and is documented accurately on the case report

Verify that the peer reviewer has attested to only the facts and that no evidence of reviewer conflict of interest exists

Ensure the provider credentials and signature are adhered to the final report

Identify any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed

Assist in resolution of client complaints and quality assurance issues as needed

Ensure all federal ERISA and state mandates are adhered to at all times

Provide 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

Active nursing licenseMedical terminology knowledgeTyping speed 40 W.P.MMicrosoft Office proficiencyCommunication skills

Required

Active nursing license required (RN/LPN/LVN)

Must be a graduate of an accredited nursing program or related medical experience; bachelor's degree preferred

Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values

Must be a qualified typist with a minimum of 40 W.P.M

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

Preferred

Bachelor's degree preferred

Benefits

Medical

Vision

Dental

Paid time off

401k

Company

MCMC Services, LLC

MCMC’s Independent Peer Review program compliments your appeal, claims, prior-auth, utilization, and case management programs by providing the comprehensive physician expertise and driven service delivery you need to meet industry and regulatory standards for medical review.

Founded in 1988