[Remote] Clinical Quality Assurance Coordinator (32357)

Note: The job is a remote job and is open to candidates in USA. Clay Consulting, LLC is seeking a Clinical Quality Assurance Coordinator to ensure that Peer Review case reports meet high standards of quality and integrity. The role involves performing quality assurance reviews, ensuring compliance with client expectations, and maintaining the highest professional standards in report preparation.ResponsibilitiesPerform quality assurance review of peer review reports, correspondences, addendums or supplemental reviewsEnsure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinationsEnsure that all client instructions and specifications have been followed and that all questions have been addressedEnsure 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 publicationsEnsure the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standardsEnsure the appropriate board specialty has reviewed the case in compliance with client specifications or state mandates and is documented accurately on the case reportVerify that the peer reviewer has attested to only the facts and that no evidence of reviewer conflict of interest existsEnsure the provider credentials and signature are adhered to the final reportIdentify any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as neededAssist in resolution of client complaints and quality assurance issues as neededEnsure all federal ERISA and state mandates are adhered to at all timesProvide insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specificationsPromote effective and efficient utilization of company resourcesParticipate in various educational and or training activities as requiredPerform other duties as assignedSkillsHigh school diploma or equivalent requiredActive nursing licenseA minimum of two years clinical or related field experience; or equivalent combination of education and experienceKnowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disabilityMust have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory valuesMust be a qualified typist with a minimum of 40 W.P.MMust be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the InternetMust possess excellent skills in English usage, grammar, punctuation and styleAbility to follow instructions and respond to upper managements' directions accuratelyDemonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is metMust demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is neededMust be able to work independently, prioritize work activities and use time efficientlyMust be able to maintain confidentialityBenefits100% remote – work from the comfort of homeWork-life balance with a structured, predictable scheduleFlexible start times three days a week (7:00–10:00am EST start)Two afternoon/evening shifts (12:00pm–8:30pm EST), with every other Friday on late shiftMES offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401kCompany OverviewClay Consulting serves the federal healthcare ecosystem from the Departments of Defense, Labor, and Justice right on down to state-level agencies. It was founded in undefined, and is headquartered in Houston, Texas, USA, with a workforce of 201-500 employees. Its website is https://clayconsultingllc.com.