[Remote] Clinical Quality Control Specialist

Note: The job is a remote job and is open to candidates in USA. Physician Life Care Planning (PLCP) is the nation’s leading provider of damages valuation services, and they are seeking a Clinical Quality Control Specialist. This role involves ensuring the quality assurance of future medical expense reports, focusing on clinical methodologies, data analysis, and process improvement.ResponsibilitiesMaintain compliance with company policies, procedures, guidelines, and any applicable requirementsAct as the designated Quality Assurance representative on applicable clinical issues by participating in methodology-conformance reviews and process risk reviews, and providing oversight of quality-improvement initiativesPromote comprehension and compliance with AAPLCP methodology, A Physician’s Guide to Life Care Planning: Tenets, Methods, and Best Practices for Physician Life Care PlannersProvide guidance to department personnel and support experts’ understanding of recognized life care planning methodology and the Company’s administrative processesInitiate administrative activities to institute quality control proceduresExpand, enhance, and maintain the Future Medical Requirement DatabaseResearch medical advances and populate such advances in databasesProvide recommendations for improvements in workflows, system functionality, quality control, and reportingManage process improvement and risk-mitigation plansParticipate in the onboarding and process orientation of associate expertsEvaluate and manage system risks and deficienciesSkillsRegistered Nurse with a minimum of a Bachelor's DegreeMinimum of 5 years of clinical experience, preferably in a Rehabilitation settingAdvanced knowledge of CPT, CDT, HCPCS, ICD-9/10 CM, and MS-DRG medical codesAdvanced knowledge of medical terminology, anatomy and physiology, pharmacology, and surgical proceduresAdvanced knowledge of usual, customary, and reasonable fee dataBroad knowledge of risk-based quality system approaches consistent with good clinical practices and life care planning methodologyExcellent verbal and written communication skills, with the ability to identify and resolve quality issues and discrepancies in a proactive, flexible, and constructive mannerDemonstrated high regard for integrity, ethical conduct, and confidentiality in support of quality-based outcomesExcellent critical thinking, analytical, and organizational skills, with strong attention to detail and a demonstrated ability to work independently in a deadline-driven, multi-project environmentFamiliarity with legal procedures relating to personal injury casesProficiency in internet researchIntermediate to Expert level skillset in Microsoft Office products (Outlook, Word, Excel) and OneNoteCompany OverviewPhysician Life Care Planning is a damages valuation company. It was founded in 2011, and is headquartered in San Antonio, Texas, USA, with a workforce of 51-200 employees. Its website is https://www.physicianlcp.com.