ExamWorks

QA Engineer

• Perform quality assurance reviews of peer review reports, correspondence, addendums and supplemental reviews
• Ensure clear, concise, evidence-based rationales support recommendations and determinations
• Verify client instructions, specifications and questions are addressed
• Confirm clinical citations and references are current and from reputable medical journals or publications
• Ensure report content, format and professional appearance meet company standards
• Verify appropriate board specialty review and accurate documentation
• Verify peer reviewer attestation and absence of conflicts of interest
• Ensure provider credentials and signatures are included in final reports
• Identify report inconsistencies and contact peer reviewers for clarification or corrections
• Assist with customer complaints and quality assurance issues
• Ensure compliance with federal ERISA and state mandates
• Provide management insight on consultant quality, availability and compliance
• Promote effective and efficient use of company resources
• Participate in required educational and training activities
• Perform other duties as assigned

Clinical Quality Assurance Coordinator

Auditor

• Perform quality utilization reviews using evidence-based guidelines
• Approve medically necessary and appropriate care
• Prepare peer review reports, correspondence, addendums, and supplemental reviews
• Work directly with providers to identify the level, intensity, and duration of care
• Evaluate medical necessity for frequency, intensity, and length of required care
• Ensure reviews meet industry quality standards and mandated turnaround times
• Maintain 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 compliance with ERISA, URAC, and other applicable guidelines
• Provide management with insight on compliance concerns
• Participate in company meetings, training activities, and continuing education
• Perform other assigned duties

Utilization Review Nurse Auditor

• Perform quality utilization review and approve medically necessary and appropriate care according to evidence-based guidelines and criteria
• Complete 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 reviews meet industry standards and required client, federal, state, or URAC turnaround times
• Maintain knowledge of URAC and other 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
• Provide management with insight on compliance concerns
• Participate in company meetings, training activities, and continuing education
• Perform other assigned duties

• Perform quality assurance reviews of peer review reports, correspondence, addendums, and supplemental reviews
• Ensure clear, concise, evidence-based rationales support recommendations and determinations
• Verify client instructions, specifications, and questions are addressed
• Verify clinical citations and references are current and from reputable medical publications
• Ensure report content, format, appearance, and compliance meet company standards
• Verify appropriate board specialty review and documentation
• Confirm peer reviewer attestation to facts and absence of conflicts of interest
• Ensure provider credentials and signature are included in final reports
• Identify report inconsistencies and contact peer reviewers for clarification or correction
• Assist with client complaints and quality assurance issues
• Ensure compliance with federal ERISA and state mandates
• Provide management insight on consultant quality, availability, and compliance
• Promote efficient utilization of company resources
• Participate in educational and training activities
• Perform other assigned duties

Client Coordinator

• Service inquiries from clients, physicians, nurses, or client representatives
• Respond to questions, report status requests, concerns, and information requests
• Enter and retrieve client or claimant information using systems and databases
• Maintain daily contact with the QA department regarding workflow and pending report status
• Contact providers for assignments and update the database
• File and archive open and closed cases
• Verify client information and document client-specific guidelines in the system
• Work independently and with team members to address questions, document activity, and return cases promptly
• Direct calls to other departments as needed
• Perform clerical duties including typing, filing, emailing, and proofreading
• Assist with customer complaints and quality assurance issues
• Notify management of report issues or concerns
• Ensure practices comply with state and federal safety and legal regulations
• Perform other duties as assigned

• Service and promptly respond to inquiries from clients and representatives regarding questions, report status, concerns, and information requests
• Enter and retrieve client or claimant information using appropriate systems and databases
• Maintain daily contact with the QA department regarding workflow and pending report status
• Contact providers for assignment and update databases
• File and archive open and closed cases
• Verify client information and document client-specific guidelines and rules in the system
• Work independently and with team members to address questions, document cases, and return cases promptly
• Direct calls to other departments as needed
• Perform clerical duties including typing, filing, emailing, and proofreading
• Assist with customer complaints and quality assurance issues
• Notify management of report issues or concerns
• Ensure practices comply with state and federal safety and legal regulations
• Perform other assigned duties

• Perform quality assurance reviews of peer review reports, correspondence, addendums, and supplemental reviews
• Ensure clear, concise, evidence-based rationales support recommendations and determinations
• Verify client instructions, specifications, questions, clinical citations, and current reputable references are addressed
• Ensure report content, format, appearance, and compliance with company standards
• Verify appropriate board specialty review and accurate documentation
• Verify peer reviewer attestation and absence of conflicts of interest
• Ensure provider credentials and signature are included in final reports
• Identify inconsistencies and contact peer reviewers for clarification, modification, or correction
• Assist with customer complaints and quality assurance issues
• Ensure compliance with federal ERISA and state mandates
• Provide management insight on consultant quality, availability, and compliance
• Promote effective and efficient use of company resources
• Participate in required educational and training activities
• Perform other duties as assigned

Risk

• Assess, implement, manage, and document security controls supporting ExamWorks and subsidiaries’ information security strategy and compliance requirements
• Advocate for an effective security program, including system-wide security analysis, intrusion and vulnerability detection, standards and testing, risk assessment, awareness and education, and policy, standard, and procedure development
• Facilitate HITRUST and SOC2 audit engagements, data/artifact collection, exception remediation, and monitoring
• Respond to client assessments and RFPs
• Conduct vendor risk assessments and reassessments
• Conduct or participate in cross-training sessions with the IT Security team on management and configuration of security tools and technical controls

InfoSec GRC Analyst

• Perform quality assurance reviews of peer review reports, correspondence, addendums, and supplemental reviews
• Ensure clear, concise, evidence-based rationales support recommendations and determinations
• Verify client instructions, specifications, questions, clinical citations, references, report quality, and company standards are satisfied
• Confirm appropriate board specialty review and accurate documentation in case reports
• Verify peer reviewer attestations and absence of conflicts of interest
• Ensure provider credentials and signatures are included in final reports
• Identify report inconsistencies and contact peer reviewers for clarification or correction
• Assist with customer complaints and quality assurance issues
• Ensure compliance with ERISA, state mandates, client specifications, and company policies
• Advise management on consultant quality, availability, and compliance
• Promote efficient use of company resources
• Participate in required educational and training activities
• Perform other assigned duties

• Perform quality assurance reviews of peer review reports, correspondence, addendums, and supplemental reviews
• Ensure clear, concise, evidence-based rationales support recommendations and determinations
• Verify client instructions, specifications, questions, clinical citations, and current reputable references are addressed
• Ensure report content, format, and professional appearance meet company standards
• Confirm appropriate board specialty review and accurate case-report documentation
• Verify peer reviewer attestations, absence of conflicts of interest, provider credentials, and signatures
• Identify report inconsistencies and contact peer reviewers for clarification, modification, or correction
• Assist with customer complaints and quality assurance issues
• Ensure compliance with federal ERISA and state mandates
• Provide management insight on consultant quality, availability, and compliance
• Promote efficient use of company resources
• Participate in educational and training activities
• Perform other assigned duties

• Assess, implement, manage, and document security controls supporting ExamWorks and subsidiaries' information security strategy and compliance requirements
• Advocate for an effective security program, including system-wide security analysis, intrusion and vulnerability detection, standards and testing, risk assessment, awareness and education, and policy, standard, and procedure development
• Facilitate HITRUST and SOC 2 audit engagements, including data/artifact collection, exception remediation, and monitoring
• Respond to client assessments and RFPs
• Conduct vendor risk assessments and reassessments
• Conduct or participate in cross-training with the IT Security team on management and configuration of security tools and technical controls

• Perform quality utilization review using acquired knowledge and evidence-based guidelines for peer review reports, correspondence, addendums, and supplemental reviews
• Work directly with providers to identify level, intensity, and duration of care
• Document findings and continue evaluating medical necessity for frequency, intensity, and length of required care
• Ensure consistency and quality of reviews meets or exceeds industry standards
• Complete quality reviews within required client, federal, state, and URAC-mandated turnaround times
• Maintain and apply knowledge of URAC and other 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 quality assurance standards, ERISA, URAC, and other state guidelines
• Provide management with insight and direction regarding compliance concerns
• Participate in company meetings, training activities, and continuing education requirements
• Perform other assigned duties

• Perform quality assurance reviews of peer review reports, correspondences, addendums, and supplemental reviews
• Ensure clear, concise, evidence-based rationales support recommendations and determinations
• Verify client instructions, specifications, and questions are addressed
• Verify clinical citations and references are current and reputable
• Ensure report content, format, and professional appearance meet company standards
• Ensure appropriate board specialty review and documentation comply with client specifications or state mandates
• Verify peer reviewer attestations and absence of conflicts of interest
• Ensure provider credentials and signatures are included in final reports
• Identify report inconsistencies and contact peer reviewers for clarification or correction
• Assist with client complaints and quality assurance issues
• Ensure compliance with federal ERISA and state mandates
• Provide management insight on consultant quality, availability, and compliance
• Promote effective and efficient use of company resources
• Participate in educational and training activities
• Perform other assigned duties

• Handle and respond promptly to client and client-representative inquiries regarding questions, report status, concerns, and information requests
• Enter and retrieve client or claimant information using appropriate systems and databases
• Maintain daily contact with the QA department regarding workflow and pending report status
• Contact providers for assignment and update the database
• File and archive open and closed cases
• Verify client information and document client-specific guidelines and information in the system
• Work independently and with team members to address, document, and return cases promptly
• Direct calls to other departments as needed
• Perform clerical duties including typing, filing, emailing, and proofreading
• Assist with customer complaints and quality assurance issues
• Notify management of report issues or concerns
• Ensure practices comply with state and federal safety and legal regulations
• Perform other duties as assigned

• Service inquiries from clients, physicians, nurses, or client representatives
• Respond to questions, report status requests, concerns, and general information requests
• Enter and retrieve client or claimant information using systems and databases
• Maintain daily contact with the QA department regarding workflow and pending report status
• Contact providers for assignments and update the database
• File and archive open and closed cases
• Verify client information and document client-specific guidelines in the system
• Work independently and with team members to address questions, document cases, and return cases promptly
• Direct calls to other departments as needed
• Perform clerical duties including typing, filing, emailing, and proofreading
• Assist with customer complaints and quality assurance issues
• Notify management of report issues or concerns
• Follow state and federal safety and legal regulations
• Perform other duties as assigned