State Licensed Clinical Quality Coordinator

Job Summary

Seeking a dedicated State Licensed Clinical Quality Coordinator, this full-time remote position will manage quality assurance reviews of peer review reports, ensuring compliance with client agreements and regulatory guidelines while working Monday to Friday, 8:30am-5:00pm EST.

Key responsibilities:

• Perform quality assurance reviews of peer review reports and ensure compliance with client specifications
• Verify that recommendations are supported by evidence-based rationales and current clinical citations
• Identify inconsistencies in reports and facilitate communication with peer reviewers for clarification or corrections

Required qualifications:

• Active RN, LPN, or LVN license required
• Minimum of two years of clinical or related field experience, or equivalent combination of education and experience
• Experience in peer review, clinical documentation review, or medical necessity assessments
• Familiarity with CMS guidelines, InterQual, Milliman/MCG, or payer policies
• Prior employment with insurance carriers, TPAs, or managed care organizations