Clinical Quality Assurance Coordinator
Posted on Oct 7, 2024 by AllMed
Portland, OR
Research
Immediate Start
Annual Salary
Full-Time
Overview:
Are you an experienced Registered Nurse (RN) with Utilization Management experience looking for your next opportunity?
AllMed is seeking a Clinical QA Coordinator to join our team!
This position is 100% remote and the schedule will be Monday-Friday 9:00am-5:30pm PST with possible weekend coverage as needed.
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.
Want to join an employee-first company with great benefits and growth opportunities? If you think this aligns with what you desire in your next career move, apply at this very moment!
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.
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.
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:
RN license 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 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.
AllMed provides clinical decision making and utilization management solutions to leading payer and provider organizations. We work closely with your team toward a shared vision of healthcare that delivers the highest quality, values patient experience, and ensures both appropriate care and utilization of health-related services.
Our solutions are developed and delivered by experts—they are thoughtfully designed to integrate seamlessly into your organization and help you deliver the right care to the right patients at the right time.
AllMed offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.
Equal Opportunity Employer - Minorities/Females/Disabled/Veterans
Are you an experienced Registered Nurse (RN) with Utilization Management experience looking for your next opportunity?
AllMed is seeking a Clinical QA Coordinator to join our team!
This position is 100% remote and the schedule will be Monday-Friday 9:00am-5:30pm PST with possible weekend coverage as needed.
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.
Want to join an employee-first company with great benefits and growth opportunities? If you think this aligns with what you desire in your next career move, apply at this very moment!
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.
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.
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:
RN license 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 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.
AllMed provides clinical decision making and utilization management solutions to leading payer and provider organizations. We work closely with your team toward a shared vision of healthcare that delivers the highest quality, values patient experience, and ensures both appropriate care and utilization of health-related services.
Our solutions are developed and delivered by experts—they are thoughtfully designed to integrate seamlessly into your organization and help you deliver the right care to the right patients at the right time.
AllMed offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.
Equal Opportunity Employer - Minorities/Females/Disabled/Veterans
Reference: 200078753
https://jobs.careeraddict.com/post/95879273
Clinical Quality Assurance Coordinator
Posted on Oct 7, 2024 by AllMed
Portland, OR
Research
Immediate Start
Annual Salary
Full-Time
Overview:
Are you an experienced Registered Nurse (RN) with Utilization Management experience looking for your next opportunity?
AllMed is seeking a Clinical QA Coordinator to join our team!
This position is 100% remote and the schedule will be Monday-Friday 9:00am-5:30pm PST with possible weekend coverage as needed.
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.
Want to join an employee-first company with great benefits and growth opportunities? If you think this aligns with what you desire in your next career move, apply at this very moment!
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.
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.
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:
RN license 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 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.
AllMed provides clinical decision making and utilization management solutions to leading payer and provider organizations. We work closely with your team toward a shared vision of healthcare that delivers the highest quality, values patient experience, and ensures both appropriate care and utilization of health-related services.
Our solutions are developed and delivered by experts—they are thoughtfully designed to integrate seamlessly into your organization and help you deliver the right care to the right patients at the right time.
AllMed offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.
Equal Opportunity Employer - Minorities/Females/Disabled/Veterans
Are you an experienced Registered Nurse (RN) with Utilization Management experience looking for your next opportunity?
AllMed is seeking a Clinical QA Coordinator to join our team!
This position is 100% remote and the schedule will be Monday-Friday 9:00am-5:30pm PST with possible weekend coverage as needed.
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.
Want to join an employee-first company with great benefits and growth opportunities? If you think this aligns with what you desire in your next career move, apply at this very moment!
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.
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.
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:
RN license 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 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.
AllMed provides clinical decision making and utilization management solutions to leading payer and provider organizations. We work closely with your team toward a shared vision of healthcare that delivers the highest quality, values patient experience, and ensures both appropriate care and utilization of health-related services.
Our solutions are developed and delivered by experts—they are thoughtfully designed to integrate seamlessly into your organization and help you deliver the right care to the right patients at the right time.
AllMed offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.
Equal Opportunity Employer - Minorities/Females/Disabled/Veterans
Reference: 200078753
Share this job:
Alert me to jobs like this:
Amplify your job search:
Expert career advice
Increase interview chances with our downloads and specialist services.
Visit Blog