ExamWorks, Inc.
Clinical Quality Assurance Coordinator (30959)
ExamWorks, Inc., Rockford, Illinois, United States, 61103
Ready for a Rewarding Career that Fits Your Lifestyle?
Imagine a job where you can keep your
clinical skills sharp , tackle exciting challenges, AND work from the comfort of your own home.
ExamWorks
is looking for a self-driven, high-performing Registered Nurse (RN) to join our dynamic team as a
Clinical Quality Assurance Coordinator .
The position is
100% remote
with a schedule of Monday through Friday with rotating weekend shifts. Hours are 7‑3:30 CT; after 2 months of training there is flexibility to start later if needed.
ESSENTIAL JOB FUNCTIONS
Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.
Ensure clear, concise, evidence‑based rationales support all recommendations and/or determinations.
Verify all client instructions, specifications, and references are current and obtained from reputable medical journals.
Confirm the review is supported by clinical citations and verified references.
Ensure the report’s content, format and appearance meet company standards.
Validate the appropriate board specialty reviewed the case per client specifications or state mandates.
Confirm peer reviewer attested only to facts and no conflict of interest exists.
Ensure provider credentials and signature are present on the final report.
Identify inconsistencies and contact the Peer Reviewer for clarification or correction.
Assist in resolution of client complaints and quality assurance issues.
Adhere to all federal ERISA and state mandates.
Provide insight to management on consultant quality, availability and compliance with company policies.
Promote efficient utilization of company resources.
Participate in educational or training activities as required.
MINIMUM REQUIRED QUALIFICATIONS
High school diploma or equivalent required.
A minimum of two years clinical or related field experience; preferred combination of education and experience.
Knowledge of the insurance industry, preferably claims management relative to workers’ compensation, no‑fault, liability or disability.
LPN/LVN/RN may be required based on business needs.
ESSENTIAL COMPETENCIES & QUALIFICATIONS
Strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
Qualified typist, minimum 40 WPM.
Full understanding of HIPAA regulations and compliance.
Proficient with general computer, fax, copier, scanner, and telephone.
Knowledge of Microsoft Word, Outlook, Excel and the Internet.
Exceptional communication skills.
Ability to follow instructions and respond accurately to upper management directions.
Demonstrate accuracy, thoroughness and continuous improvement of quality.
Work independently, prioritize activities and use time efficiently.
Maintain confidentiality and promote a positive team‑oriented environment.
Maintain focus and concentration under normal or heavy distractions.
Work well under pressure or stressful conditions.
Manage change, delays, or unexpected events appropriately.
Follow all company policies and procedures in effect at the time of hire.
LANGUAGE & COMMUNICATION SKILLS
Read, analyze and interpret common correspondence, medical records, and legal documents.
Write clearly and informatively to all required audiences and edit own work for appropriate spelling and grammar.
Respond appropriately and professionally to all inquiries or complaints from customers, physicians, regulatory agencies, and/or members of the business community.
Effectively present information one‑on‑one or in small groups.
PHYSICAL DEMANDS
Work at a desk or similar office‑type furnishings up to 8 hours a day or longer.
Operate a computer up to 4 hours at a time.
Travel to different floors of the office or other locations.
Move throughout the office.
Occasionally lift and/or carry up to 10 lbs.
Occasionally push/pull up to 10 lbs.
Occasionally subject to bending, squatting or twisting.
WORK ENVIRONMENT
Extended hours are occasionally required beyond the regular eight (8) hour work day.
The noise level in the work environment is usually moderate.
ExamWorks, LLC is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.
Equal Opportunity Employer – Minorities/Females/Disabled/Veterans
#J-18808-Ljbffr
Imagine a job where you can keep your
clinical skills sharp , tackle exciting challenges, AND work from the comfort of your own home.
ExamWorks
is looking for a self-driven, high-performing Registered Nurse (RN) to join our dynamic team as a
Clinical Quality Assurance Coordinator .
The position is
100% remote
with a schedule of Monday through Friday with rotating weekend shifts. Hours are 7‑3:30 CT; after 2 months of training there is flexibility to start later if needed.
ESSENTIAL JOB FUNCTIONS
Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.
Ensure clear, concise, evidence‑based rationales support all recommendations and/or determinations.
Verify all client instructions, specifications, and references are current and obtained from reputable medical journals.
Confirm the review is supported by clinical citations and verified references.
Ensure the report’s content, format and appearance meet company standards.
Validate the appropriate board specialty reviewed the case per client specifications or state mandates.
Confirm peer reviewer attested only to facts and no conflict of interest exists.
Ensure provider credentials and signature are present on the final report.
Identify inconsistencies and contact the Peer Reviewer for clarification or correction.
Assist in resolution of client complaints and quality assurance issues.
Adhere to all federal ERISA and state mandates.
Provide insight to management on consultant quality, availability and compliance with company policies.
Promote efficient utilization of company resources.
Participate in educational or training activities as required.
MINIMUM REQUIRED QUALIFICATIONS
High school diploma or equivalent required.
A minimum of two years clinical or related field experience; preferred combination of education and experience.
Knowledge of the insurance industry, preferably claims management relative to workers’ compensation, no‑fault, liability or disability.
LPN/LVN/RN may be required based on business needs.
ESSENTIAL COMPETENCIES & QUALIFICATIONS
Strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
Qualified typist, minimum 40 WPM.
Full understanding of HIPAA regulations and compliance.
Proficient with general computer, fax, copier, scanner, and telephone.
Knowledge of Microsoft Word, Outlook, Excel and the Internet.
Exceptional communication skills.
Ability to follow instructions and respond accurately to upper management directions.
Demonstrate accuracy, thoroughness and continuous improvement of quality.
Work independently, prioritize activities and use time efficiently.
Maintain confidentiality and promote a positive team‑oriented environment.
Maintain focus and concentration under normal or heavy distractions.
Work well under pressure or stressful conditions.
Manage change, delays, or unexpected events appropriately.
Follow all company policies and procedures in effect at the time of hire.
LANGUAGE & COMMUNICATION SKILLS
Read, analyze and interpret common correspondence, medical records, and legal documents.
Write clearly and informatively to all required audiences and edit own work for appropriate spelling and grammar.
Respond appropriately and professionally to all inquiries or complaints from customers, physicians, regulatory agencies, and/or members of the business community.
Effectively present information one‑on‑one or in small groups.
PHYSICAL DEMANDS
Work at a desk or similar office‑type furnishings up to 8 hours a day or longer.
Operate a computer up to 4 hours at a time.
Travel to different floors of the office or other locations.
Move throughout the office.
Occasionally lift and/or carry up to 10 lbs.
Occasionally push/pull up to 10 lbs.
Occasionally subject to bending, squatting or twisting.
WORK ENVIRONMENT
Extended hours are occasionally required beyond the regular eight (8) hour work day.
The noise level in the work environment is usually moderate.
ExamWorks, LLC is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.
Equal Opportunity Employer – Minorities/Females/Disabled/Veterans
#J-18808-Ljbffr