• Clinical Quality Assurance Nurse

    Requisition ID
    # of Openings
  • Overview

    Looking for a role that doesn’t require working nights, holidays or weekends? Looking to stay in the nursing world and utilize your clinical background? Exam Works offers nurses an ideal work/life balance, allowing you to work from home three days per week!


    We are seeking passionate and skilled RN’s to serve as a Clinical QA Nurse (internally known as Clinical QA Coordinator), reviewing cases and ensuring all necessary information has been provided and is accurate before sending back to requestor.


    This is a full-time position, requiring you to be in office two days a week and allows you work from home three days a week once fully trained.


    Hours during training: Mon-Thu 12-8:30, Fri 7-3:30
    Hours after training: 3 days 12-8:30 and 2 days 7-3:30 or 8-4:30




    • 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.





    • RN license required.
    • High school diploma or equivalent required.
    • A minimum of two years clinical or related field experience; or equivalent combination of education and experience. 
    • Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
    • Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages.
    • Must be a qualified typist with a minimum of 40 W.P.M
    • 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 possess excellent skills in English usage, grammar, punctuation and style.
    • Ability to follow instructions and respond to upper managements’ directions accurately.
    • Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
    • Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
    • 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.


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