Clinical Quality Assurance Coordinator (32720)

Before applying, please note that this role is open exclusively to Registered Nurses (RNs).

Ready to use your clinical expertise in a whole new way?

If you're a Registered Nurse (RN) who thrives on critical thinking, attention to detail, and want to make a real impact behind the scenes, this could be the perfect fit.

We're looking for a Clinical Quality Assurance Coordinator to join our growing team. In this role you’ll play a vital role in ensuring Peer Review case reports meet the highest standards of quality and integrity - while staying fully aligned with client expectations, regulatory requirements, and state and federal guidelines. Your expertise will help elevate outcomes and support excellence across the board.

Why nurses love this role:

*100% Remote - Skip the commute and work from home
*Work-Life Balance - Monday-Friday, 10:00am-6:30pm CT
*Use Your Clinical Knowledge Differently - Apply your nursing expertise beyond direct patient care
*Grow With Us - Supportive leadership, strong benefits, and opportunities for advancement

If you're looking for a rewarding next chapter where your clinical judgment and attention to detail truly shine, we'd love to connect.

Responsibilities may include:

• Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.
• Ensure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
• Ensure that all client instructions and specifications have been followed and that all questions have been addressed.
• Ensure each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.
• Ensure the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
• Ensure the appropriate board specialty has reviewed the case in compliance with client specifications or state mandates and is documented accurately on the case report.
• Verify that the peer reviewer has attested to only the facts and that no evidence of reviewer conflict of interest exists.
• Ensure the provider credentials and signature are adhered to the final report.
• Identify any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.
• Assist in resolution of client complaints and quality assurance issues as needed.
• Ensure all federal ERISA and state mandates are adhered to at all times.
• Provide insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.
• Promote effective and efficient utilization of company resources.
• Participate in various educational and or training activities as required.
• Perform other duties as assigned.