Clinical Quality Assurance Coordinator (30393)

Looking for a Career That Works for You? We’ve Got It.

Imagine a role where your clinical expertise stays sharp, your day is filled with meaningful work, and your commute is just a few steps from the coffee machine. Sound good? Let’s make it happen.

ExamWorks is on the hunt for a motivated, detail-driven RN to join our team as a Clinical Quality Assurance Coordinator. You’ll be the final set of eyes on our Peer Review case reports - ensuring every detail meets the highest standards of quality, compliance, and integrity.

• 100% Remote - work from home where you’re most productive! 
• Monday–Friday, 8:00 AM–4:30 PM CT - a schedule to keep your work-life balance on point.
• Impactful Work 

If you're ready to bring your A-game from wherever you call home, we’d love to meet you.

Duties and Responsibilities may include:

• 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.

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.