Clinical Quality Assurance Coordinator

ExamWorks

. Perform quality utilization review using acquired knowledge and evidence-based guidelines for peer review reports, correspondence, addendums, and supplemental reviews .

Posted 9/18/2026full-timeRemote • Oregon • United StatesMid-LevelSenior💰 $40 - $42 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Utilization Review, ensuring compliance with URAC and federal regulations while maintaining high standards of quality and accuracy in medical necessity evaluations. Proficient in medical terminology and effective communication with healthcare providers to facilitate optimal patient care.

Highest-signal resume keywords

Unencumbered Nursing LicenseUtilization Review ExperienceKnowledge of URAC RegulationsStrong Medical Terminology KnowledgeHIPAA Compliance Understanding

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization ReviewMedical TerminologyAnatomy and Physiology KnowledgeTyping Speed of 40 W.P.M.Quality Assurance StandardsRegulatory ComplianceMedical Necessity EvaluationDocumentation SkillsClient Complaint ResolutionData Entry Accuracy

Soft Skills

Exceptional Communication SkillsAbility to Work IndependentlyTime ManagementAbility to Work Under PressureAttention to Detail

Tools & Technologies

Microsoft WordMicrosoft OutlookMicrosoft ExcelInternet ProficiencyFax MachineCopierScannerTelephone

Certifications & Qualifications

Unencumbered Nursing License

Industry Keywords

URACERISAPeer ReviewQuality Utilization ReviewFederal RegulationsState GuidelinesClient Determination LettersContinuing Education

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

Must hold and maintain an unencumbered Nursing license
UMR or IRO experience
Remote work experience
Strong knowledge of medical terminology, anatomy and physiology, medications, and laboratory values
Qualified typist with a minimum of 40 W.P.M.
Full understanding of HIPAA regulations and compliance
Ability to operate a computer, fax, copier, scanner, and telephone
Knowledge of Microsoft Word, Outlook, Excel, and the Internet
Exceptional communication skills
Ability to follow instructions and management directions accurately
Accuracy and thoroughness
Ability to work independently, prioritize work activities, and use time efficiently
Ability to maintain confidentiality
Ability to work well under pressure or stressful conditions
Ability to manage change, delays, or unexpected events appropriately
Ability to follow company policies and procedures

Benefits

Comp & perks

100% remote opportunity
Flexible work from home
Medical, vision, and dental benefits
Paid time off
401k
Continuing education opportunities