ExamWorks operates at the intersection of healthcare, consulting, and legal services, providing independent medical examinations and peer reviews for claims and related processes. Its work also includes bill reviews, Medicare compliance, medical-record and document management, and compliance auditing.
The company supports a broad physician network and develops enterprise platforms and workflow tools for healthcare organizations. Its teams combine clinical, operational, compliance, and technology expertise to help clients manage medical records and claims with greater consistency and reliability.
Remote Clinical Quality Assurance Coordinator (RN, LPN, or LVN)
Review peer review reports for MCMC, a healthcare utilization and quality review provider, to help ensure clinical accuracy, compliance, and complete documentation. This full-time remote role is open to licensed nurses in the United States.
Description
- Review peer review reports, correspondence, addenda, and supplemental reviews for quality.
- Check that recommendations and determinations have clear, concise, evidence-based rationales.
- Confirm compliance with client instructions, specifications, federal ERISA requirements, and state mandates.
- Check for current, reputable clinical citations and references when applicable.
- Review report content, formatting, professional presentation, and adherence to company standards.
- Confirm that reviews are assigned to the appropriate board specialty and case reports are documented accurately.
- Check peer reviewer attestations and confirm there are no conflicts of interest.
- Ensure final reports include provider credentials and signatures.
- Identify inconsistencies and contact peer reviewers to clarify or correct reports.
- Help address client complaints and quality assurance issues.
- Share insights with management on consultants’ quality, availability, and compliance.
- Support effective and efficient use of company resources.
- Take part in educational and training activities.
- Complete other duties as assigned.
Requirements
- Applicants must be RN, LPN, or LVN.
- An active RN, LPN, or LVN license is required.
- Graduate of an accredited nursing program or have related medical experience.
- Strong knowledge of medical terminology, anatomy and physiology, medications, and laboratory values.
- Typing proficiency of at least 40 words per minute.
- Familiarity with Microsoft Word, Outlook, Excel, and the internet.
- Excellent English usage, grammar, punctuation, and writing style.
- Ability to follow instructions and accurately carry out management directions.
- Accuracy and attention to detail.
- Ability to work independently, prioritize tasks, and manage time efficiently.
- Ability to maintain confidentiality.
- Ability to contribute positively in a team-oriented environment.
- Ability to stay focused amid normal or heavy distractions.
- Ability to work effectively under pressure or in stressful conditions.
- Ability to adapt appropriately to change, delays, or unexpected events.
Benefits
- Fully remote work from home.
- Predictable Monday-to-Friday schedule.
- Medical, vision, and dental coverage.
- Paid time off.
- 401(k) plan.
- Professional development opportunities.