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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in quality assurance processes, ensuring compliance with federal ERISA and state mandates while maintaining high standards in report content and professional appearance. Proficient in medical terminology and clinical documentation, with strong analytical and communication skills.
Highest-signal resume keywords
Active RN/LPN Nursing LicenseQuality Assurance ReviewsMedical Terminology KnowledgeClinical ExperienceMicrosoft Office Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Quality AssuranceMedical TerminologyAnatomy and PhysiologyArithmetic CalculationsClinical DocumentationReport FormattingEvidence-Based RationalesPeer Review ProcessesConfidentiality MaintenanceTyping Speed of 40 W.P.M.
Soft Skills
Attention to DetailIndependent WorkTime ManagementEffective CommunicationProblem-Solving
Tools & Technologies
Microsoft WordMicrosoft ExcelMicrosoft OutlookFax MachineScannerCopierTelephone
Certifications & Qualifications
Active RN/LPN Nursing License
Industry Keywords
ERISA ComplianceClinical CitationsProvider CredentialsPeer Reviewer AttestationsCustomer Complaints Management
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, 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
Requirements
What you’ll need- Active RN/LPN nursing license required
- Graduate of an accredited nursing program or related medical experience
- Bachelor's degree preferred
- Minimum of two years clinical or related field experience, or equivalent combination of education and experience
- Strong knowledge of medical terminology, anatomy and physiology, medications, and laboratory values
- Ability to perform arithmetic calculations involving whole numbers and decimals and 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 skills
- Ability to follow instructions and respond accurately to management directions
- Ability to work independently, prioritize work, and use time efficiently
- Ability to maintain confidentiality
Benefits
Comp & perks- Fully remote work arrangement
- Medical, vision, and dental benefits
- Paid time off
- 401k
- Competitive benefits