[Remote] Clinical Quality Control Specialist

Note: The job is a remote job and is open to candidates in USA. Physician Life Care Planning (PLCP) is the nation’s leading provider of damages valuation services, and they are seeking a Clinical Quality Control Specialist. This role involves ensuring the quality assurance of future medical expense reports, focusing on clinical methodologies, data analysis, and process improvement.

Responsibilities

• Maintain compliance with company policies, procedures, guidelines, and any applicable requirements
• Act as the designated Quality Assurance representative on applicable clinical issues by participating in methodology-conformance reviews and process risk reviews, and providing oversight of quality-improvement initiatives
• Promote comprehension and compliance with AAPLCP methodology, A Physician’s Guide to Life Care Planning: Tenets, Methods, and Best Practices for Physician Life Care Planners
• Provide guidance to department personnel and support experts’ understanding of recognized life care planning methodology and the Company’s administrative processes
• Initiate administrative activities to institute quality control procedures
• Expand, enhance, and maintain the Future Medical Requirement Database
• Research medical advances and populate such advances in databases
• Provide recommendations for improvements in workflows, system functionality, quality control, and reporting
• Manage process improvement and risk-mitigation plans
• Participate in the onboarding and process orientation of associate experts
• Evaluate and manage system risks and deficiencies

Skills

• Registered Nurse with a minimum of a Bachelor's Degree
• Minimum of 5 years of clinical experience, preferably in a Rehabilitation setting
• Advanced knowledge of CPT, CDT, HCPCS, ICD-9/10 CM, and MS-DRG medical codes
• Advanced knowledge of medical terminology, anatomy and physiology, pharmacology, and surgical procedures
• Advanced knowledge of usual, customary, and reasonable fee data
• Broad knowledge of risk-based quality system approaches consistent with good clinical practices and life care planning methodology
• Excellent verbal and written communication skills, with the ability to identify and resolve quality issues and discrepancies in a proactive, flexible, and constructive manner
• Demonstrated high regard for integrity, ethical conduct, and confidentiality in support of quality-based outcomes
• Excellent critical thinking, analytical, and organizational skills, with strong attention to detail and a demonstrated ability to work independently in a deadline-driven, multi-project environment
• Familiarity with legal procedures relating to personal injury cases
• Proficiency in internet research
• Intermediate to Expert level skillset in Microsoft Office products (Outlook, Word, Excel) and OneNote

Company Overview