Clinical Quality Assurance Coordinator

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.

Ready for a Rewarding Career that Fits Your Lifestyle? Imagine a job where you can keep your clinical skills sharp, tackle exciting challenges, AND work from the comfort of your own home. Sounds like the perfect mix, right? MCMC is looking for a self-driven, high-performing Nurse (LPN, LVN or RN) to join our dynamic team as a Clinical Quality Assurance Coordinator. In this role, you’ll ensure our Peer Review case reports are nothing short of exceptional—delivering top-notch quality and integrity, all while staying fully aligned with client agreements, regulatory standards, and state and federal mandates. The position is 100% remote with a schedule of Monday through Friday, 11:30am-8:00pm EST, with occasional holiday coverage and possible weekend coverage as needed. Could you be our next great addition to the MCMC family? Let's find out!

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.