Clinical Quality Assurance Coordinator

Job Details

Job Location:

Rockford, IL 61108

Position Type:
Full Time Salary Range: $28.50 - $28.50 Hourly Before applying, please note that this role is open exclusively to Registered Nurses (RNs).

Ready to use your clinical expertise in a whole new way?

If you're a Registered Nurse (RN) who thrives on critical thinking, attention to detail, and want to make a real impact behind the scenes, this could be the perfect fit.

We're looking for a Clinical Quality Assurance Coordinator to join our growing team. In this role you’ll play a vital role in ensuring Peer Review case reports meet the highest standards of quality and integrity - while staying fully aligned with client expectations, regulatory requirements, and state and federal guidelines. Your expertise will help elevate outcomes and support excellence across the board.

• 100% Remote
  - Skip the commute and work from home
• Work-Life Balance
  - Monday-Friday, 10:00am-6:30pm CT
• Use Your Clinical Knowledge Differently
  - Apply your nursing expertise beyond direct patient care
• Grow With Us
  - Supportive leadership, strong benefits, and opportunities for advancement

If you're looking for a rewarding next chapter where your clinical judgment and attention to detail truly shine, we'd love to connect.

• 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.

• Nursing license.
• 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 preferred.
• 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.
• Must demonstrate accuracy and…