Clinical Quality Assurance Coordinator

AllMed Healthcare Management

. Perform quality utilization reviews using acquired knowledge and evidence-based guidelines .

Posted 11/7/2026full-timeRemote • Oregon • United StatesMid-LevelSenior💰 $38 - $41 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in conducting quality utilization reviews, ensuring compliance with URAC and federal regulations, and maintaining accurate documentation. Possesses strong knowledge of medical terminology and the ability to communicate effectively with healthcare providers and management.

Highest-signal resume keywords

Unencumbered Nursing LicenseURAC Compliance KnowledgeMedical Terminology ProficiencyUMR or IRO ExperienceHIPAA Regulations Understanding

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Quality Utilization ReviewMedical Necessity EvaluationPeer Review Report PreparationTyping Speed of 40 W.P.M.Knowledge of Anatomy and Physiology

Soft Skills

Exceptional Communication SkillsAbility to Work IndependentlyAccuracy and ThoroughnessAbility to Manage ChangeAbility to Work Under Pressure

Tools & Technologies

Microsoft WordMicrosoft OutlookMicrosoft ExcelDatabase ManagementFax Machine

Certifications & Qualifications

Nursing License

Industry Keywords

URAC StandardsFederal ERISA GuidelinesClient Complaints ManagementQuality AssuranceEvidence-Based Guidelines

About the role

Key responsibilities & impact

Perform quality utilization reviews using acquired knowledge and evidence-based guidelines
Review and approve care based on medical necessity and appropriateness
Prepare and review peer review reports, correspondence, addendums, and supplemental reviews
Work directly with providers to identify level, intensity, and duration of care
Document findings and evaluate medical necessity for frequency, intensity, and length of care
Ensure review consistency and quality meets or exceeds industry standards
Complete quality reviews within client, federal, state, and URAC-mandated turnaround times
Maintain and apply knowledge of URAC and state and federal regulatory requirements
Maintain accurate utilization review records in the appropriate database
Direct Customer Service Representatives to ensure timely delivery of determination letters
Assist with client complaints and quality assurance issues
Ensure adherence to federal ERISA, URAC, and other state guidelines
Provide management with insight and direction on compliance concerns
Participate in company meetings, training activities, and continuing education
Perform other assigned duties

Requirements

What you’ll need

Must hold and maintain an unencumbered Nursing license
UMR or IRO experience
Remote work experience
Strong knowledge of medical terminology, anatomy and physiology, medications, and laboratory values
Qualified typist with a minimum of 40 W.P.M.
Full understanding of HIPAA regulations and compliance
Ability to operate a computer, fax, copier, scanner, and telephone
Knowledge of Microsoft Word, Outlook, Excel, and the Internet
Exceptional communication skills
Ability to follow instructions and respond accurately to upper management directions
Accuracy and thoroughness
Ability to work independently, prioritize work activities, and use time efficiently
Ability to maintain confidentiality
Ability to work well under pressure or stressful conditions
Ability to manage change, delays, or unexpected events appropriately
Ability to follow company policies and procedures

Benefits

Comp & perks

100% remote work from home
Flexible work arrangement
Medical, vision, and dental benefits
Paid time off
401(k)
Continuing education requirements