Clinical Quality Assurance Coordinator

Description

Direct IME is looking for a Clinical Quality Assurance Coordinator to join our team!

The Clinical Quality Assurance Coordinator is responsible for ensuring case reports are of the highest quality and integrity and in full compliance with client contractual agreements, regulatory agency standards and federal and provincial mandates. This position is required to handle quality assurance questions and provide support to the Quality Assurance Department.

The schedule for this role is Monday to Friday 9am-5pm.

Responsibilties

• Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.
• Review reports to assure no grammatical, typographical or compositional errors exist.
• 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.
• Follow up with assessors to ensure edits are completed and in the case of Multi-Disciplinary evaluations, facilitate delivery and review of all reports involved in the evaluation process.
• 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 Assessor to obtain clarification, modification or correction as needed.
• Assist in resolution of client complaints and quality assurance issues as needed.
• 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.
  
  

Qualifications

EDUCATION AND/OR EXPERIENCE

• Post-Secondary education is an asset.
• Relevant experience in IME work is an asset.
• Regulated Health Professional is an asset.
• A minimum of two years clinical or related field experience; or equivalent combination of education and experience preferred. Knowledge of the insurance industry, preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, or disability preferred
  
  

Qualifications

• 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 have a full understanding of HIPAA regulations and compliance.
• Must be able to operate a general computer, fax, copier, scanner, and telephone.
• Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
• Must demonstrate exceptional communication skills.
• Ability to follow instructions and respond to upper managements’ directions accurately.
• Must demonstrate accuracy and thoroughness. Look for ways to improve and promote quality and monitors own work to ensure quality is met.
• 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.
• Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.
  
  

About Us

Direct IME is one of Canada’s leading providers of independent medical assessments for a reason: your goal is our goal. At Direct IME we provide services to the legal community as well as insurers and employers. In the medical-legal sector whether its liability, medical malpractice, plaintiff or defense counsel, we provide unbiased medical reports across the entire spectrum. In the employment and insurance sector we assist in facilitating healthy employees and satisfied plan members through timely diagnosis, pro-active objective treatment recommendations, and most importantly, evidentiary opinion on return to work.

Direct IME 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, colour, religion, sex, sexual orientation, gender identity, national origin, age, or any other status protected under provincial or federal laws.