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Are you an experienced Licensed Practical Nurse (LPN or LVN) or Registered Nurse (RN) looking for your next opportunity?
MCMC is seeking a *Remote* Clinical QA Coordinator (LPN/RN) to join our team!
This position is 100% remote and the schedule will be Monday- Friday 11:30am-8pm EST (occasional holiday coverage required, possible weekend coverage as needed).
The Clinical Quality Assurance Coordinator is responsible for ensuring Peer Review case reports are of the highest quality and integrity and in full compliance with client contractual agreement, regulatory agency standards and/or federal and state mandates.
Want to join an employee-first company with great benefits and growth opportunities? If you think this aligns with what you desire in your next career move, apply at this very moment!
EDUCATION AND/OR EXPERIENCE
High school diploma or equivalent required. A minimum of two years clinical or related field experience; or equivalent combination of education and experience. Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability.
QUALIFICATIONS
About Us:
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
Full Time
$68k-84k (estimate)
12/03/2023
03/05/2025
mcmcllc.com
DURHAM, NC
25 - 50
2011
MARIA C MONTALVO-COLLINS
$5M - $10M
MCMCs Independent Peer Review program compliments your appeal, claims, prior-auth, utilization, and case management programs by providing the comprehensive physician expertise and driven service delivery you need to meet industry and regulatory standards for medical review. MCMCs range of services includes everything from pre-certification reviews to complex, high-tech policy reviews, and for health plans, insurance carriers, pharmacy benefit managers, self-funded employer groups, third-party administrators, hospitals, and state-mandated external review programs. Independent Peer Review Turn t...o the source that most health plans rely on for their peer review services. MCMC is the source you can trust to provide premier service for all your peer review needs. Peer Review Services Pre-certification/prior authorization Retrospective Appeals Concurrent Fraud and abuse Telephone conference/consultation Quality assessments Medical expert testimony Criteria review Legal Review Clinical trials MCMC reviews address the following issues: Medical necessity Covered benefits based on plan language Experimental or investigational procedures Level of care Drug formulary compliance Employee leave assessment Alternative treatments Length of stay Impairment, work restrictions and limitations Procedural coding
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