Clinical Quality Assurance Coordinator

3 weeks ago

Rockville, United States MCMC Full time

Overview:

Are you an experienced Licensed Practical Nurse (LPN or LVN) or Registered Nurse (RN) looking for your next opportunity?

MCMC is seeking a Clinical QA Coordinator to join our team

This position is 100% remote with a 4 10's schedule. Saturday and Sunday from 8:00am-6:30pm EST are required and then you'll be asked to work 2 consistent weekdays per week. Those 2 days will be determined upon hire.

The Clinical Quality Assurance Coordinator is responsible for ensuring Peer Review case reports are of the highest quality and integrity and in full compliance with client contractual agreement, regulatory agency standards and/or federal and state mandates.

Want to join an employee-first company with great benefits and growth opportunities? If you think this aligns with what you desire in your next career move, apply at this very moment

Responsibilities:
  • Performs quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.
  • Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
  • Ensures that all client instructions and specifications have been followed and that all questions have been addressed.
  • Ensures 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.
  • Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
  • Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.
  • Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.
  • Ensures the provider credentials and signature are adhered to the final report.
  • Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.
  • Assists in resolution of customer complaints and quality assurance issues as needed.
  • Ensures all federal ERISA and/or state mandates are adhered to at all times.
  • Provides 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.


Qualifications:

EDUCATION AND/OR EXPERIENCE

High school diploma or equivalent required. A minimum of two years clinical or related field experience; or equivalent combination of education and experience. Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability.

QUALIFICATIONS

  • Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
  • Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages.
  • Must be a qualified typist with a minimum of 40 W.P.M
  • Must be able to operate a general computer, fax, copier, scanner, and telephone.
  • Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
  • Must possess excellent skills in English usage, grammar, punctuation and style.
  • Ability to follow instructions and respond to upper managements directions accurately.
  • Demonstrates accuracy and thoroughness.
  • Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
  • Must be able to work independently, prioritize work activities and use time efficiently.
  • Must be able to maintain confidentiality.

MCMC completes over 100,000 reviews each year for more than 400 clients, including almost all of the nations largest Health Plans, PBMs, Disability Carriers, TPAs, UR companies, Self-Insured Employers, Taft-Hartley Plans and Government Organizations.

MCMC 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.

MCMC offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.

Equal Opportunity Employer - Minorities/Females/Disabled/Veterans

  • Senior Quality Assurance Specialist

    1 month ago

    Rockville, Maryland, United States Quality Agents Full time

    Job OverviewQuality Agents is a leading service company providing validation and quality expertise to the pharmaceutical and biotechnology industries. We are seeking a skilled Senior Quality Assurance Specialist to join our team.Key Responsibilities:* Provide quality assurance and validation expertise to clients* Develop and implement quality management...

  • Quality Assurance Supervisor

    4 weeks ago

    Rockville, Maryland, United States Inotiv Full time

    Job Summary:We are seeking a highly skilled Quality Assurance Supervisor to join our team at Inotiv. As a Quality Assurance Supervisor, you will be responsible for overseeing all Quality Assurance (QA) functions, including audits of ongoing operation processes, protocol review, data, study reports, and general study compliance with regulatory requirements...

  • Quality Assurance Supervisor

    4 weeks ago

    Rockville, Minnesota, United States Inotiv Full time

    Job Summary:We are seeking a highly skilled Quality Assurance Supervisor to join our team at Inotiv. As a key member of our quality management team, you will be responsible for ensuring compliance with regulatory requirements and industry standards.Key Responsibilities:Lead and manage a team of quality auditors to ensure compliance with regulatory...

  • Clinical Protocol Coordinator

    3 weeks ago

    Rockville, United States Cape Fox Shared Services Full time

    Concentric Methods is seeking a Clinical Protocol Coordinator to join our ream in Bethesda, MD in support of the NIH. Responsibilities: Assists researchers with protocol development, assembly and review of clinical trial documents. Assist researchers develop, prepare internal research proposals, abstract submissions, poster presentations and manuscript...

  • Quality Assurance Specialist

    1 month ago

    Rockville, Maryland, United States Actalent Full time

    Job Title: Quality Assurance SpecialistAs a Quality Assurance Specialist, you will be responsible for ensuring the quality and compliance of analytical testing programs. This includes product release and stability testing, as well as partnering with QC analysts to learn and contribute to the team for technical information.This role requires a strong...

  • Quality Assurance Supervisor

    4 weeks ago

    Rockville, Minnesota, United States Inotiv Full time

    Job SummaryAs a Quality Assurance Supervisor at Inotiv, you will be responsible for overseeing all Quality Assurance (QA) functions, including audits of ongoing operation processes, protocol review, data, study reports, and general study compliance with regulatory requirements and SOPs. You will also oversee the QA team, including the growth and development...

  • Performance Engineer

    4 weeks ago

    Rockville, Maryland, United States X-energy Full time

    Job Summary:X-energy LLC is seeking a highly skilled Performance Engineer to join our Quality Assurance team. As a key member of our team, you will be responsible for performing Quality Assurance services in support of our reactor development projects. This includes documenting, implementing, and maintaining quality management systems to ensure compliance...

  • Senior Quality Assurance Engineer

    4 weeks ago

    Rockville, Maryland, United States X Energy, LLC Full time

    Job SummaryX Energy, LLC is seeking a highly skilled Senior Quality Assurance Engineer to join our Quality Assurance team. As a key member of our team, you will be responsible for ensuring the quality of our reactor development projects, including documenting, implementing, and maintaining quality management systems.Key ResponsibilitiesEnsure processes and...

  • Quality Assurance Associate

    4 weeks ago

    Rockville, Maryland, United States Food Lion Full time

    Job Summary:As a Quality Assurance Associate at Food Lion, you will play a vital role in maintaining a clean, safe, and inviting shopping environment for our customers. Your primary responsibility will be to ensure that our stores meet the highest standards of quality and cleanliness, minimizing shrink and adhering to company guidelines and policies.Key...

  • Quality Assurance

    1 day ago

    Rockville, United States TechnoGen Full time

    Role name: Quality Assurance /Salesforce TESTER Branch | City | Location:- Seattle, WA|| Rockville,MD || Bellevue, WA || OVERLAND PARK, KS Competencies: Digital : Salesforce Community Cloud Experience (Years): 6-8 Role Description: Knowledge of Salesforce permissions, roles, reports, dashboards, and logical formulas? Develop, implement, and maintain...

  • Quality Assurance Analyst Position

    4 weeks ago

    Rockville, Maryland, United States DealerOn, Inc. Full time

    Job Title: Quality Assurance AnalystJob Summary:We are seeking a Quality Assurance Analyst to join our team at DealerOn, Inc. The successful candidate will be responsible for testing efforts and stability of our Platform and Content Management System (CMS).Key Responsibilities:Work directly within domain teams to test and deliver high-quality software...

  • Senior Software Quality Assurance Engineer

    4 weeks ago

    Rockville, Minnesota, United States Meso Scale Discovery Full time

    Job SummaryThe Senior Software Quality Assurance Engineer is responsible for ensuring the quality of major components of present and future MSD software products. This role involves creating, improving, maintaining, and executing a testing framework (manual and automated) to verify and validate software products.Key Responsibilities- Independently develop...

  • Technical Quality Specialist

    2 weeks ago

    Rockville, United States Kaiser Permanente Full time

    Job Summary:Under the direction of the Department Director or Manager, formulate, implement and direct programs, policies and procedures which assure quality and standardization of departmental technical services in all Mid-Atlantic Region Laboratories. Act as region-wide technical advisor for laboratory personnel and Mid-Atlantic Permanente Clinicians. in...

  • Lead Quality Assurance Specialist for Pharmaceutical Reference Materials

    4 weeks ago

    Rockville, Maryland, United States United States Pharmacopeia Full time

    About United States PharmacopeiaAt United States Pharmacopeia, we are committed to protecting and strengthening the quality of medicines and related products for the benefit of the public. Our mission is to advance public health through quality medicines and standards.We are a scientific organization that collaborates with the world's top authorities in...

  • Technical Quality Specialist

    1 week ago

    Rockville, United States Kaiser Permanente Full time

    Job Summary: Under the direction of the Department Director or Manager, formulate, implement and direct programs, policies and procedures which assure quality and standardization of departmental technical services in all Mid-Atlantic Region Laboratories. Act as region-wide technical advisor for laboratory personnel and Mid-Atlantic Permanente Clinicians. in...

  • Quality Assurance/Quality Control

    2 weeks ago

    Rockville, United States BTI Security Full time

    Quality Assurance/Quality Control (QA/QC)Inspecting Contracts: Ensure contract compliance from the beginning of the request for proposal process through the management of each contract.Recording: Record quality issues and investigate causes of non-compliance.Improving processes: propose ways to improve processes and procedures to reduce compliance issues and...

  • Research Nurse

    1 month ago

    Rockville, Maryland, United States Cape Fox Shared Services Full time

    Job Title: Research NurseCape Fox Shared Services is seeking a highly skilled Research Nurse to join our team in Bethesda, MD. As a Research Nurse, you will play a critical role in supporting the NIH and contributing to the success of our clinical trials.Key Responsibilities:Recruit and screen patients for inclusion in protocols and clinical trials.Assist...

  • Senior SAS Programmer and Data Coordinator

    4 weeks ago

    Rockville, Minnesota, United States George Washington University Full time

    Job Title: Senior SAS Programmer and Data CoordinatorJob Summary:The George Washington University is seeking a highly skilled Senior SAS Programmer and Data Coordinator to join its team. As a key member of the Biostatistics Center, you will be responsible for assisting study teams in study reporting, data quality and assurance, and creation of clinical...

  • Clinical Operations Manager RN, Shady Grove MOB

    2 weeks ago

    Rockville, United States Kaiser Permanente Full time

    div> Job Summary: To serve as the on-site leadership for the ambulatory operations. Coordinates the daily delivery of quality patient care in the integrated Care Delivery system, and delivers the optimal member experience. Executes on the service delivery model in partnership with the Chief and Director, and drives performance goals outlined in the annual...

  • Clinical Research Coordinator

    4 weeks ago

    Rockville, Minnesota, United States Axle Full time

    Job OverviewAxle is seeking a highly skilled Clinical Research Coordinator to join our dynamic team. The ideal candidate will have a strong background in clinical research and experience in developing clinical research protocols and informed consents.Key Responsibilities:Develop clinical research protocols and informed consents for evaluation of...