Clinical Quality Assurance Coordinator (32277)

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    "description": "<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><em>This role is designed for licensed nursing professionals.&nbsp;</em><em>To be considered, you must hold an active RN, LPN, or LVN license.&nbsp;&nbsp;</em></span></span></p>\n\n<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><strong>Craving a New Adventure? Flex Your Clinical Skills Right from Your Couch!</strong></span></span></p>\n\n<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Are you a Nurse (LPN, LVN or RN) seeking a role that challenges you, helps you grow, and lets you work from the comfort of your own home? ExamWorks has the perfect opportunity for you!</span></span></p>\n\n<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">We&rsquo;re looking for a <strong>Clinical Quality Assurance Coordinator</strong> to join our team! In this role, you&rsquo;ll ensure Peer Review case reports meet the highest standards of quality, integrity, and compliance with client agreements, regulatory guidelines, and federal/state mandates.&nbsp;</span></span></p>\n\n<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">We are targeting nurses with:</span></span></p>\n\n<ul>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">experience with <strong>peer review, clinical documentation review, or medical necessity assessments.</strong></span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">familiarity with <strong>CMS guidelines, InterQual, Milliman/MCG, or payer policies.</strong></span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">prior employment with <strong>insurance carriers, TPAs, or managed care organizations.</strong></span></span></li>\n</ul>\n\n<p><span style=\"display:block; 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font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Ensure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Ensure that all client instructions and specifications have been followed and that all questions have been addressed.</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,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></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,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></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,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></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,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></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Ensure the provider credentials and signature are adhered to the final report.</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Identify any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Assist in resolution of client complaints and quality assurance issues as needed.</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Ensure all federal ERISA and state mandates are adhered to at all times.</span></span></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,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></li>\n\t<li><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Promote effective and efficient utilization of company resources.</span></span></li>\n\t<li><span style=\"display:block; 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Looks 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 demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.</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</ul>\n\n<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers&#39; compensation insurance coverages.</span></span></p>\n\n<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.</span></span></p>\n\n<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><strong>Equal Opportunity Employer - Minorities/Females/Disabled/Veterans</strong></span></span></p>\n\n<p><span style=\"display:block; font-size:12px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><strong><u>ExamWorks</u></strong>&nbsp;offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k</span></span></p>\n",
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