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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 clinical documentation and reporting. Proficient in medical terminology, anatomy, and physiology, with strong analytical skills to address client specifications and enhance report accuracy.
Highest-signal resume keywords
Active RN/LPN Nursing LicenseQuality Assurance ReviewMedical Terminology KnowledgeClinical DocumentationMicrosoft Office Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
Quality AssuranceClinical ReviewMedical TerminologyAnatomy and PhysiologyArithmetic CalculationsTyping (40 W.P.M.)Report WritingDocumentation VerificationCompliance MonitoringClient Communication
Soft Skills
Attention to DetailIndependent WorkTime ManagementConfidentiality MaintenanceEffective Communication
Tools & Technologies
Microsoft WordMicrosoft OutlookMicrosoft ExcelFax MachineCopierScannerTelephone
Certifications & Qualifications
Active RN/LPN Nursing License
Industry Keywords
ERISA ComplianceClinical ExperiencePeer ReviewMedical JournalsHealthcare Standards
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 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
Requirements
What you’ll need- Active RN/LPN nursing license required
- Must be a graduate of an accredited nursing program or have 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, 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 and respond accurately to management directions
- Ability to work independently, prioritize work and use time efficiently
- Ability to maintain confidentiality
Benefits
Comp & perks- Competitive benefits (medical, vision, dental)
- Paid time off
- 401k