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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 for documentation and reporting. Proficient in medical terminology and clinical practices, with strong communication and organizational skills to effectively manage peer review activities.
Highest-signal resume keywords
Active RN/LPN Nursing LicenseQuality Assurance ReviewsMedical Terminology KnowledgeRegulatory ComplianceExceptional Communication Skills
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 AssuranceClinical ExperienceArithmetic CalculationsMedical TerminologyAnatomy and Physiology KnowledgeLaboratory Values KnowledgeTyping Speed of 40 W.P.M.Documentation AccuracyEvidence-Based RationalesPeer Review Processes
Soft Skills
Attention to DetailTime ManagementIndependencePrioritizationConfidentiality Maintenance
Tools & Technologies
Microsoft WordMicrosoft OutlookMicrosoft ExcelComputer OperationFax MachineCopierScannerTelephone
Certifications & Qualifications
Active RN/LPN Nursing License
Industry Keywords
ERISA ComplianceClinical CitationsPeer Reviewer AttestationsProvider CredentialsBoard Specialty Review
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 references are properly addressed
- Ensure reports meet company standards for content, format, professional appearance, and regulatory compliance
- Confirm appropriate board specialty review and accurate 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 with insight on consultant quality, availability, and compliance
- Promote efficient utilization of company resources
- Participate in 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 with 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
- Ability to follow instructions and respond accurately to management directions
- Demonstrated accuracy and thoroughness
- Exceptional communication skills
- 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
- Fast-paced team atmosphere