Clinical Quality Assurance Coordinator - Lead

Location

Rockville, MD | United States

Job description

No matter where you are in your nursing career, we'd love to hear from you because  MCMC is seeking a *Remote* Clinical QA Coordinator Lead (LPN/RN)to join our team! 

The Clinical Quality Assurance Coordinator Lead is responsible to assist 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.

ESSENTIAL DUTIES AND RESPONSIBILITIES TO PERFORM THIS JOB SUCCESSFULLY INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING :

• 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
• Participates in the development and implementation of policies and procedures in order to provide advice and guidance.
• Participate in various educational and or training activities as required
• Perform other duties as assigned  

SUPERVISORY RESPONSIBILITIES

Directly support and when required supervise and carry out supervisory responsibilities in accordance with ExamWorks’ policies and applicable laws. Responsibilities include, but are not limited to:

• Adhere to all hiring procedures in accordance with the company’s Hiring Policy and Procedures Guide.
• Ensure effective and efficient training procedures are in place and adhered to.
• Delegate and direct work duties as instructed by
• Promote a positive working environment through appropriate recognition and reward programs.
• Reports all employee disciplinary concerns to the department Manager.

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.

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.

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

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