Clinical Quality Assurance Coordinator

Before applying, please note that this role is open exclusively to RN, LPN or LVN.
Ready to put your clinical expertise to work in a new way, all from the comfort of home?
MCMC is seeking a motivated, detail-oriented nurse who thrives on critical thinking and takes pride in delivering high-quality work. If you're looking for an opportunity to apply your clinical knowledge beyond direct patient care while making a meaningful impact, this could be the role for you.
Why This Opportunity Stands Out

• 100% Remote – Enjoy the flexibility of working from home.
• Predictable Schedule – Monday through Friday, 11:30am-8:00pm EST, with occasional weekend and holiday coverage.
• Use Your Clinical Skills Differently – Stay connected to healthcare while developing expertise in quality assurance and peer review.
• Make an Impact – Help ensure the integrity and quality of important clinical reviews that influence decision-making every day.

• 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.

• 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…