$31.

00 Hourly paid time off, 401(k) United States, Michigan, Southfield Jun 18, 2026 Description This role is designed for licensed nursing professionals. To be considered, you must hold an active RN, LPN, or LVN license. Craving a Adventure? Flex Your Clinical Skills Right from Your Couch! Are you a Nurse (LPN, LVN or RN) seeking a role that challenges you, helps you grow, and lets you work from the comfort of your own home? ExamWorks has the perfect opportunity for you! We're looking for a Clinical Quality Assurance Coordinator to join our team! In this role, you'll ensure Peer Review case reports meet the highest standards of quality, integrity, and compliance with client agreements, regulatory guidelines, and federal/state mandates.

We are targeting nurses with:

experience with peer review, clinical documentation review, or medical necessity assessments.\nfamiliarity with CMS guidelines, InterQual, Milliman/MCG, or payer policies.\nprior employment with insurance carriers, TPAs, or managed care organizations.

Why This Role Rocks:

100% Remote

Enjoy the flexibility of working from home!\nImpactful Work
You'll play a key role in ensuring the quality and compliance of critical reports.\nSchedule
Monday to Friday; 8:30am-5:00pm EST Responsibilities may include: Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.

\nEnsure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.\nEnsure that all client instructions and specifications have been followed and that all questions have been addressed.\nEnsure 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.\nEnsure the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.\nEnsure the appropriate board specialty has reviewed the case in compliance with client specifications or state mandates and is documented accurately on the case report.\nVerify that the peer reviewer has attested to only the facts and that no evidence of reviewer conflict of interest exists.\nEnsure the provider credentials and signature are adhered to the final report.\nIdentify any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.\nAssist in resolution of client complaints and quality assurance issues as needed.\nEnsure all federal ERISA and state mandates are adhered to at all times.\nProvide insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.\nPromote effective and efficient utilization of company resources.\nParticipate in various educational and or training activities as required.\nPerform other duties as assigned. Qualifications High school diploma or equivalent required with a minimum of two years clinical or related field experience; or equivalent combination of education and experience.\nExperience in peer review, clinical documentation review, or medical necessity assessments.\nFamiliarity with CMS guidelines, InterQual, Milliman/MCG, or payer policies.\nPrior employment with insurance carriers, TPAs, or managed care organizations.\nMust have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.\nMust be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages.\nMust be a qualified typist with a minimum of 40 W.P.M\nMust be able to operate a general computer, fax, copier, scanner, and telephone.\nMust be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.\nMust possess excellent skills in English usage, grammar, punctuation and style.\nAbility to follow instructions and respond to upper managements' directions accurately.\nDemonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.\nMust demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.\nMust be able to work independently, prioritize work activities and use time efficiently.\nMust be able to maintain confidentiality. ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages. Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws. Equal Opportunity Employer

Minorities/Females/Disabled/Veterans ExamWorks offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k

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