logo

Clinical Quality Assurance Coordinator – Lead

  • Permanent
  • Anywhere

Website Examworks Group, Inc.

Examworks Group, Inc.

Company : Examworks Group, Inc.

Country: United States

Location : Rockford, Illinois

Post: Sat, 30 Jul 2022 21:41:49 GMT

Expires: Sat, 27 Aug 2022 23:59:59 GMT

Apply Job : Apply Online

—————————— Job Description ——————————

Overview:
ExamWorks is seeking a 100% Remote Clinical Quality Assurance Coordinator Lead to join our team!

You will be responsible for assisting in the daily workflow of the department, analyze medical records and handle quality assurance questions on medical necessity, utilization review and peer review files as needed. This position is required to have a complete understanding of the duties required below and provide overall direction and support to the Quality Assurance Department.

The schedule for this role is Monday – Friday 9:00am to 5:30pm CT.

 

Responsibilities:
Provides overall support to the department and assists in the daily distribution of work and ensures all timelines are met and operations are run in the most effective and efficient way possible.

Performs quality assurance review of reports, correspondences and/or addendums or supplemental review.

Conduct concurrent medical record review using specific indicators and criteria in accordance with company policy and procedures

Promotes effective and efficient utilization of all clinical resources and makes necessary recommendations for improvements to management as needed.

Utilize resources, as needed, to achieve expected goal within the required timeframe

Communicates with physicians to maintain appropriate patient outcomes

Assists in resolution of customer complaints and quality assurance issues as needed.

Provides insight and direction to management on consultant quality, availability and compliance with all company policies and procedures.

Promote effective and efficient utilization of clinical resources

Qualifications:
EDUCATION AND/OR EXPERIENCE 

Bachelor degree in nursing or related field; or minimum five years related experience; or equivalent combination of education and experience. Knowledge of the insurance industry, preferably claims management, relative to workers’ compensation, no-fault, liability, and disability is desired.

 

CERTIFICATES, LICENSES, REGISTRATIONS

Registered Nursing license preferred, but not required in all business units of the company.

 

QUALIFICATIONS 

Must possess a working knowledge of medical legal aspects of medical records and health information principles and/or liability

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

Analyzes problems involving multiple interrelated causes.  Where necessary, gathers information and applies complex concepts or methods to generate an effective solution

Must possess complete knowledge of general computer, fax, copier, scanner, and telephone

Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Excel, and the Internet.

Ability to follow instructions and respond to upper managements’ directions accurately

Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.

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.

Must be able to demonstrate and promote a positive team -oriented environment.

Must be able to stay focused and concentrate under normal or heavy distractions.

Must be able to work well under pressure and or stressful conditions.

Must possess the ability to manage and direct change, delays, or unexpected events appropriately.

 

 

ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers’ compensation insurance coverages.

 

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

To apply for this job please visit www.resume-library.com.