Clinical Quality Assurance Coordinator (32080)

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    "jobTitle": "Clinical Quality Assurance Coordinator (32080)",
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    "description": "<p style=\"text-align:justify;\"><span style=\"font-size:10pt;\"><span style=\"font-family:Courier;\"><strong><span style=\"font-size:11pt;\"><span style=\"font-family:Calibri, sans-serif;\">SUMMARY</span></span></strong> </span></span></p>\n<p style=\"text-align:justify;\"><span style=\"font-size:10pt;\"><span style=\"font-family:Courier;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Calibri, sans-serif;\">The Clinical Quality Assurance Coordinator is responsible for ensuring case reports are of the highest quality and integrity and in full compliance with client contractual agreements, regulatory agency standards and federal and state mandates. This position is required to handle quality assurance questions and provide support to the Quality Assurance Department. </span></span></span></span></p>\n<p style=\"text-align:justify;\"> </p>\n<p style=\"text-align:justify;\"><span style=\"font-size:10pt;\"><span style=\"font-family:Courier;\"><strong><span style=\"font-size:11pt;\"><span style=\"font-family:Calibri, sans-serif;\">ESSENTIAL JOB FUNCTIONS</span></span></strong></span></span></p>\n<ul>\n\t<li style=\"text-align:justify;\"><span style=\"font-size:10pt;\"><span style=\"font-family:Courier;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Calibri, sans-serif;\">Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.</span></span></span></span></li>\n\t<li style=\"text-align:justify;\"><span style=\"font-size:10pt;\"><span style=\"font-family:Courier;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Calibri, sans-serif;\">Ensure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.</span></span></span></span></li>\n\t<li style=\"text-align:justify;\"><span style=\"font-size:10pt;\"><span style=\"font-family:Courier;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Calibri, sans-serif;\">Ensure that all client instructions and specifications have been followed and that all questions have been addressed.</span></span></span></span></li>\n\t<li style=\"text-align:justify;\"><span style=\"font-size:10pt;\"><span style=\"font-family:Courier;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Calibri, sans-serif;\">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.</span></span></span></span></li>\n\t<li style=\"text-align:justify;\"><span style=\"font-size:10pt;\"><span style=\"font-family:Courier;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Calibri, sans-serif;\">Ensure the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.</span></span></span></span></li>\n\t<li style=\"text-align:justify;\"><span style=\"font-size:10pt;\"><span style=\"font-family:Courier;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Calibri, sans-serif;\">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.</span></span></span></span></li>\n\t<li style=\"text-align:justify;\"><span style=\"font-size:10pt;\"><span style=\"font-family:Courier;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Calibri, sans-serif;\">Verify that the peer reviewer has attested to only the facts and that no evidence of reviewer conflict of interest exists.</span></span></span></span></li>\n\t<li style=\"text-align:justify;\"><span style=\"font-size:10pt;\"><span style=\"font-family:Courier;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Calibri, sans-serif;\">Ensure the provider credentials and signature are adhered to the final report.</span></span></span></span></li>\n\t<li style=\"text-align:justify;\"><span style=\"font-size:10pt;\"><span style=\"font-family:Courier;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Calibri, sans-serif;\">Identify any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.</span></span></span></span></li>\n\t<li style=\"text-align:justify;\"><span style=\"font-size:10pt;\"><span style=\"font-family:Courier;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Calibri, sans-serif;\">Assist in resolution of client complaints and quality assurance issues as needed.</span></span></span></span></li>\n\t<li style=\"text-align:justify;\"><span style=\"font-size:10pt;\"><span style=\"font-family:Courier;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Calibri, sans-serif;\">Ensure all federal ERISA and state mandates are adhered to at all times.</span></span></span></span></li>\n\t<li style=\"text-align:justify;\"><span style=\"font-size:10pt;\"><span style=\"font-family:Courier;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Calibri, sans-serif;\">Provide insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.</span></span></span></span></li>\n\t<li style=\"text-align:justify;\"><span style=\"font-size:10pt;\"><span style=\"font-family:Courier;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Calibri, sans-serif;\">Promote effective and efficient utilization of company resources.</span></span></span></span></li>\n\t<li style=\"text-align:justify;\"><span style=\"font-size:10pt;\"><span style=\"font-family:Courier;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Calibri, sans-serif;\">Participate in various educational and or training activities as required.</span></span></span></span></li>\n\t<li style=\"text-align:justify;\"><span style=\"font-size:10pt;\"><span style=\"font-family:Courier;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Calibri, sans-serif;\">Perform other duties as assigned.</span></span></span></span></li>\n</ul>\n\n<p style=\"text-align:justify;\"> </p>",
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Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.\\n\\n\\n\\tExtended hours are occasionally required beyond the regular eight (8) hour work day.\\n\\n\\n&nbsp;\\n\\nNOTE:\\n\\nThis job description is intended to provide a general overview of the responsibilities and requirements for the Medical Assistant position. Specific duties and responsibilities may vary based on the clinic&#39;s needs and may be subject to change at the discretion of the employer.\\n\\n&nbsp;\\n\\nMES offers our vendors a vast network of providers who perform Compensation and Pension (C&amp;P) exams, Separation Health Assessments (SHAs), and Reserve Health Readiness Program (RHRP) evaluations for our Nation&#39;s Veterans. Our offices are outfitted with state-of-the-art equipment and highly skilled medical professionals. We pride ourselves on delivering quality services in a timely manner.\\n\\n\\nMES is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.\\n\\nEqual Opportunity Employer&nbsp;- Minorities/Females/Disabled/Veterans\\n\",\"experienceRequirements\":\"MINIMUM REQUIRED QUALIFICATIONS\\n\\nEducation and/or Experience &nbsp;\\n\\n&bull; High school diploma or equivalent required.\\n&bull; Minimum of two (2) years of clinical or related experience preferred, or an equivalent combination of education and experience.\\n&bull; Knowledge of the insurance industry, including claims management (workers&rsquo; compensation, no-fault, liability, or disability), preferred.\\n\\nCertificates, Licenses, Registrations \\n\\nLPN/LVN/RN may be required based on business needs.\\n\\n&nbsp;\\n\\nESSENTIAL COMPETENCIES \\n\\nQUALIFICATIONS&nbsp; \\n\\n\\n\\tMust have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.\\n\\tMust be a qualified typist with a minimum of 40 W.P.M\\n\\tMust have a full understanding of HIPAA regulations and compliance.\\n\\tMust be able to operate a general computer, fax, copier, scanner, and telephone.\\n\\tMust be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.\\n\\tMust demonstrate exceptional communication skills.\\n\\tAbility to follow instructions and respond to upper managements&rsquo; directions accurately.\\n\\tMust demonstrate accuracy and thoroughness. 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    "qualifications": "<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><strong>MINIMUM REQUIRED QUALIFICATIONS</strong></span></span></p>\n\n<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><strong>Education and/or Experience </strong>&nbsp;</span></span></p>\n\n<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">&bull; High school diploma or equivalent required.<br />\n&bull; Minimum of two (2) years of clinical or related experience preferred, or an equivalent combination of education and experience.<br />\n&bull; Knowledge of the insurance industry, including claims management (workers&rsquo; compensation, no-fault, liability, or disability), preferred.</span></span></p>\n\n<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><strong>Certificates, Licenses, Registrations </strong></span></span></p>\n\n<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">LPN/LVN/RN may be required based on business needs.</span></span></p>\n\n<p>&nbsp;</p>\n\n<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><strong>ESSENTIAL COMPETENCIES </strong></span></span></p>\n\n<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><strong>QUALIFICATIONS&nbsp; </strong></span></span></p>\n\n<ul>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Must be a qualified typist with a minimum of 40 W.P.M</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Must have a full understanding of HIPAA regulations and compliance.</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Must be able to operate a general computer, fax, copier, scanner, and telephone.</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Must demonstrate exceptional communication skills.</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Ability to follow instructions and respond to upper managements&rsquo; directions accurately.</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Must demonstrate accuracy and thoroughness. Look for ways to improve and promote quality and monitors own work to ensure quality is met.</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Must be able to work independently, prioritize work activities and use time efficiently.</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Must be able to maintain confidentiality.</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Must be able to demonstrate and promote a positive team -oriented environment.</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Must be able to stay focused and concentrate under normal or heavy distractions.</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Must be able to work well under pressure and or stressful conditions.</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Must possess the ability to manage change, delays, or unexpected events appropriately.</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.</span></span></li>\n</ul>\n\n<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><strong>LANGUAGE/COMMUNICATION SKILLS </strong></span></span></p>\n\n<ul>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Ability to read, analyze and interpret common correspondence, medical records, and legal contracts and documents.</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Ability to write clearly and informatively to all required audiences and edit own work for appropriate spelling and grammar.</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Ability to respond appropriately and professionally to all inquiries or complaints from customers, physicians, regulatory agencies, and/or members of the business community.&nbsp;</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Ability to effectively present information one-on-one or in small groups.</span></span></li>\n</ul>\n\n<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><strong>PHYSICAL DEMANDS&nbsp; </strong></span></span></p>\n\n<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.&nbsp; Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</span></span></p>\n\n<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">This position generally consists of:</span></span></p>\n\n<ul>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Ability to work at a desk or similar office-type furnishings up to 8 hours a day or longer as required by business needs.</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Ability to operate a computer up to 4 hours at a time.</span></span></li>\n</ul>\n\n<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><strong>WORK ENVIRONMENT </strong></span></span></p>\n\n<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</span></span></p>\n\n<ul>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Extended hours are occasionally required beyond the regular eight (8) hour work day.</span></span></li>\n</ul>\n\n<p>&nbsp;</p>\n\n<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><strong>NOTE:</strong></span></span></p>\n\n<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">This job description is intended to provide a general overview of the responsibilities and requirements for the Medical Assistant position. Specific duties and responsibilities may vary based on the clinic&#39;s needs and may be subject to change at the discretion of the employer.</span></span></p>\n\n<p>&nbsp;</p>\n\n<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><strong>MES</strong> offers our vendors a vast network of providers who perform Compensation and Pension (C&amp;P) exams, Separation Health Assessments (SHAs), and Reserve Health Readiness Program (RHRP) evaluations for our Nation&#39;s Veterans. Our offices are outfitted with state-of-the-art equipment and highly skilled medical professionals. We pride ourselves on delivering quality services in a timely manner.<br />\n<br />\n<br />\n<strong>MES</strong> is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.<br />\n<br />\n<strong>Equal Opportunity Employer</strong><strong>&nbsp;</strong>- Minorities/Females/Disabled/Veterans</span></span></p>\n",
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