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MES Solutions
MES Solutions
201 – 500 Xodimlar
HuquqKonsaltingSog‘liqni saqlash

MES Solutions mustaqil tibbiy baholashlar, hamkasblar ekspertizasi hamda tegishli klinik va ma’muriy xizmatlar orqali sug‘urta da’volari va xatarlarni boshqarish sohasini qo‘llab-quvvatlaydi. Kompaniya faoliyatiga Mustaqil Tibbiy Ko‘riklarni muvofiqlashtirish, tibbiy hujjatlarni olish va ko‘rib chiqish, shifokorlar malakasini tasdiqlash jarayonlarini boshqarish, shuningdek mehnatga layoqatlilik va nogironlikni baholashga ko‘maklashish kiradi.

Kompaniya avtomobil, nogironlik, javobgarlik, xodimlarga tovon puli va guruhli tibbiy sug‘urta yo‘nalishlarida sug‘urta tashkilotlari, uchinchi tomon ma’murlari, o‘zini o‘zi sug‘urtalovchi ish beruvchilar, davlat idoralari va advokatlarga xizmat ko‘rsatadi. MES Solutions, shuningdek, HIPAA, HITECH va HITRUST talablariga muvofiqlikka alohida e’tibor qaratadi hamda da’volar va xatarlar bo‘yicha qarorlar qabul qilishda mustaqil tibbiy xulosaga muhtoj tashkilotlar uchun sog‘liqni saqlash, huquq va konsalting sohalaridagi tajribani birlashtiradi.

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Kompaniyadagi ish o‘rinlari

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.

USAmerika Qo‘shma ShtatlariMAMassachusets
27 $ – 29 $ / soat
MasofaviyTo‘liq stavkaJuniorO‘rta darajaTalab Qilinadigan Til: inglizchaQA muhandisi

Tavsif

  • 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

Talablar

  • 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

Imtiyozlar

  • 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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