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Clinical Quality Assurance Coordinator
MES Solutions. Perform quality assurance reviews of peer review reports, correspondence, addendums, and supplemental reviews .
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 accuracy and documentation. Proficient in medical terminology and effective communication, with a strong ability to manage client interactions and resolve quality assurance issues.
Highest-signal resume keywords
Active Nursing License (RN/LPN/LVN)Quality Assurance ReviewMedical Terminology KnowledgeMicrosoft Office ProficiencyExceptional 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 Assurance ReviewMedical Terminology KnowledgeAnatomy and Physiology KnowledgeLaboratory Values KnowledgeTyping Speed (40 W.P.M.)
Soft Skills
Attention to DetailAbility to Work IndependentlyTime ManagementAbility to Work Under PressureExceptional Communication Skills
Tools & Technologies
Microsoft WordMicrosoft OutlookMicrosoft ExcelInternet Proficiency
Certifications & Qualifications
Active Nursing License (RN/LPN/LVN)
Industry Keywords
ERISA CompliancePeer ReviewClinical CitationsProvider CredentialsClient 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 and specifications are followed and all questions are addressed
- Verify clinical citations and references are current and from reputable medical publications
- 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 report inconsistencies and contact peer reviewers for clarification or correction
- Assist with client 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 educational and training activities
- Perform other duties as assigned
Requirements
What you’ll need- Role open exclusively to RN, LPN, or LVN
- Active nursing license required (RN/LPN/LVN)
- Graduate of an accredited nursing program or related medical experience
- Bachelor's degree preferred
- Strong knowledge of medical terminology, anatomy and physiology, medications, and laboratory values
- Qualified typist with a minimum of 40 W.P.M.
- Knowledge of Microsoft Word, Outlook, Excel, and the Internet
- Excellent English usage, grammar, punctuation, and style
- Ability to follow instructions and respond accurately to upper management directions
- Accuracy, thoroughness, and quality monitoring
- Exceptional communication skills
- Ability to work independently, prioritize work, 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
Benefits
Comp & perks- 100% Remote – Enjoy the flexibility of working from home
- Predictable Monday–Friday schedule
- Competitive benefits: medical, vision, and dental
- Paid time off
- 401k
- Educational and training activities