Clinical Quality Assurance Coordinator (33175)

Before applying, please note that this role is open exclusively to RN, LPN or LVN.

Ready to put your clinical expertise to work in a new way, all from the comfort of home?

MCMC is seeking a motivated, detail-oriented nurse who thrives on critical thinking and takes pride in delivering high-quality work. If you're looking for an opportunity to apply your clinical knowledge beyond direct patient care while making a meaningful impact, this could be the role for you.

As a Clinical Quality Assurance Coordinator, you'll play a key role in reviewing Peer Review case reports to ensure they meet the highest standards of quality, accuracy, and compliance. Your clinical expertise will help support fair, consistent outcomes while ensuring alignment with client expectations and regulatory requirements.

This position is 100% remote with great work-life balance! Choose the schedule that works best for you. Options include Monday through Friday (11:30am-8:00pm EST), a Sunday through Thursday schedule (Sunday 8:00am-4:30pm EST and Monday through Thursday 11:30am-8:00pm EST), or a four-day workweek with 10-hour shifts (Saturday and Sunday 8:00am-6:30pm EST, plus two weekdays). Occasional weekend and holiday coverage may be required, but you'll always know your schedule in advance, making it easier to balance work, family, and personal commitments.

If you're ready for a role that combines clinical judgment, attention to detail, and professional growth, we'd love to connect with you.

Responsibilities may include:

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

• Active nursing license required (RN/LPN/LVN).
• Must be a graduate of an accredited nursing program or related medical experience; bachelor's degree preferred.
• Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
• Must be a qualified typist with a minimum of 40 W.P.M
• 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. 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 change, delays, or unexpected events appropriately.

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

Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.

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