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About the role
Key responsibilities & impact- 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
Requirements
What you’ll need- Active RN or LPN nursing license required
- Graduate of an accredited nursing program or related medical experience
- Minimum of two years clinical or related field experience, or equivalent combination of education and experience
- Bachelor's degree preferred
- Strong knowledge of medical terminology, anatomy and physiology, medications, and laboratory values
- Ability to compute rates and percentages
- Qualified typist with a minimum of 40 W.P.M.
- Ability to operate a computer, fax, copier, scanner, and telephone
- Knowledge of Microsoft Word, Outlook, Excel, and the Internet
- Excellent English usage, grammar, punctuation, and style
- Ability to follow instructions accurately
- Exceptional communication skills
- Ability to work independently, prioritize activities, and use time efficiently
- Ability to maintain confidentiality
Benefits
Comp & perks- Fully remote work
- Medical, vision, and dental benefits
- Paid time off
- 401k
- No travel required