Clinical Quality Assurance Coordinator

at IME Resources LLC in Rockford, Illinois, United States

Job Description

Clinical Quality Assurance Coordinator

Requisition ID 
2024-10468  

# of Openings 
1  

Category 
Operations  

 Location  
US-IL-Rockford
Overview

Calling all Weekend Warrior Nurses from Across the U.S.
Are you looking for a position that is challenging, will keep your clinical skills sharp, but doing so from the comfort of home?
ExamWorks is seeking a self-motivated, high-performing nurse (LPN/LVN or RN) to join our team.
The Clinical Quality Assurance Coordinator is responsible for ensuring Peer Review case reports are of the highest quality and integrity and in full compliance with client contractual agreement, regulatory agency standards and/or federal and state mandates.
The position is 100% remote with a schedule of Wednesday-Friday 8:30am-5:00pm CT and Saturday-Sunday 7:30am-4:00pm CT. There may be some flexibility with the set schedule.
Are you motivated, energetic, and excited to become part of the ExamWorks team? If so, you might be our next new team member!

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.
Qualifications

High school diploma or equivalent required. A minimum of two years clinical or related field experience; or equivalent combination of education and experience. Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability.

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... For full info follow application link.

It is the policy of ExamWorks Group, Inc. and its subsidiaries to employ qualified persons of the greatest ability without discrimination against any employee or applicant for employment because of race, religion, color, sex, physical or mental disability, national origin, age, status as a disabled veteran, a recently separated veteran, an Armed Forces service medal veteran or other protected veteran or any other protected group status and further, to take affirmative action to employ and advance in employment qualified minorities, women, disabled persons, disabled veterans, recently separated veterans, Armed Forces service medal veterans or other protected veterans