Clinical Quality Assurance Coordinator (32445)

**Ready for a Rewarding Career that Fits Your Lifestyle?** Imagine a job where you can keep your **clinical skills sharp**, tackle exciting challenges, AND work from the comfort of your own home. Sounds like the perfect mix, right? **MES** is looking for a **self-driven, high-performing Registered Nurse (RN)** to join our dynamic team as a **Clinical Quality Assurance Coordinator**. In this role, you’ll ensure our **Peer Review case reports** are nothing short of exceptional—delivering top-notch quality and integrity, all while staying fully aligned with **client agreements**, **regulatory standards**, and **state and federal mandates**. The position is **100% remote** with a schedule of **Monday through Friday:** - 2 days: 8am-4:30pm EST - 1 day: 10am-6:30pm EST - 2 days: 12am-8:30pm EST ( Friday is mandatory for one of the 12-8:30 shifts). - 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. If you’re ready to make a real impact in healthcare, all while enjoying the flexibility of working remotely, we want to hear from you! - 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 qu…