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MES Solutions स्वतंत्र चिकित्सीय मूल्यांकन, सहकर्मी समीक्षाओं तथा संबंधित नैदानिक और प्रशासनिक सेवाओं के माध्यम से दावों और जोखिम-प्रबंधन समुदाय का सहयोग करता है। इसके कार्यों में स्वतंत्र चिकित्सीय परीक्षाओं का समन्वय, चिकित्सा अभिलेख प्राप्त करना और उनकी समीक्षा करना, चिकित्सकों की प्रमाण-पत्र प्रक्रिया का प्रबंधन तथा कार्य-योग्यता और दिव्यांगता आकलनों में सहयोग देना शामिल है।
कंपनी ऑटो, दिव्यांगता, देयता, श्रमिक मुआवज़ा और समूह स्वास्थ्य क्षेत्रों में बीमाकर्ताओं, तृतीय-पक्ष प्रशासकों, स्वयं-बीमित नियोक्ताओं, सरकारी एजेंसियों और वकीलों को सेवाएँ प्रदान करती है। MES Solutions HIPAA, HITECH और HITRUST के अनुपालन पर भी ज़ोर देता है तथा उन संगठनों के लिए स्वास्थ्य सेवा, कानूनी और परामर्श विशेषज्ञता को एक साथ लाता है जिन्हें दावों और जोखिम संबंधी निर्णयों में स्वतंत्र चिकित्सीय अंतर्दृष्टि की आवश्यकता होती है।
Clinical Quality Assurance Coordinator - Remote in Massachusetts
MES Solutions is hiring a Clinical Quality Assurance Coordinator to review medical peer-review reports, validate evidence-based documentation, and support regulatory compliance. This full-time remote role serves Massachusetts-based operations.
विवरण
- Review peer-review reports, correspondence, addenda, and supplemental reviews for quality
- Ensure recommendations and determinations are supported by clear, concise, evidence-based rationales
- Confirm that client instructions, specifications, and questions are fully addressed
- Check that clinical citations and references are current and sourced from reputable medical publications
- Verify that reports meet company standards for content, formatting, and professional presentation
- Confirm reviews are assigned to the appropriate board specialty and documented accurately
- Validate peer reviewer attestations and the absence of conflicts of interest
- Ensure final reports include provider credentials and signatures
- Identify inconsistencies and contact peer reviewers to request clarification or corrections
- Support the resolution of customer complaints and quality assurance concerns
- Maintain compliance with federal ERISA requirements and applicable state mandates
- Provide management with information about consultant quality, availability, and compliance
- Help promote efficient and effective use of company resources
- Complete required educational and training activities
- Carry out other duties assigned by management
आवश्यकताएँ
- An active RN or LPN nursing license is required
- Graduation from an accredited nursing program or related medical experience is required
- A bachelor's degree is preferred
- At least two years of clinical or related experience, or an equivalent combination of education and experience
- Strong knowledge of medical terminology, anatomy and physiology, medications, and laboratory values
- Ability to perform calculations using whole numbers, decimals, rates, and percentages
- Typing proficiency of at least 40 words per minute
- Ability to use computers, fax machines, copiers, scanners, and telephones
- Working knowledge of Microsoft Word, Outlook, Excel, and the internet
- Excellent command of English usage, grammar, punctuation, and style
- Ability to follow instructions and accurately act on management direction
- Consistent accuracy and attention to detail
- Exceptional communication skills
- Ability to work independently, prioritize tasks, and manage time efficiently
- Ability to protect confidential information
लाभ
- Medical insurance coverage
- Vision insurance coverage
- Dental insurance coverage
- Paid time off
- 401(k) plan
- Fully remote work arrangement
- Monday-through-Friday schedule
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