Clinical Quality Assurance Specialist

Why Work for Us?

Workplace well-being is more important than ever. We are the winner of the 2018, 2019, 2020, 2021, 2022, and 2023 Best and Brightest Companies to Work for In the Nation. We have also won the 2020 Best Places to Work Award, Minneapolis/St. Paul Business Journal.

Workplace well-being is more important than ever. We are the winner of the 2018, 2019, 2020, 2021, 2022 and 2023 Best and Brightest Companies to Work for In the Nation. We have also won the 2020 Best Places to Work Award, Minneapolis/St. Paul Business Journal.

Our employees benefit from a competitive benefits package that includes paid time off (PTO), paid parental leave, paid holidays, insurance (medical, dental, vision, life, STD, LTD), flexible schedules, a 401k program with company match, and profit sharing. Insurance benefits are effective on the 1st of the month following month of hire.

We strive to develop and provide growth opportunities for our employees. In 2022, R3 Continuum spent approximately $32,500 on employee training and development.

At R3 Continuum, we believe our differences don’t divide us but teach us. R3 Continuum eagerly embraces diversity and is a committed Equal Opportunity Employer to all qualified applicants, ensuring individuals will not be discriminated against based on any protected classifications.

Join a company dedicated to helping people and organizations be more resilient and thrive.

Essential Functions

• Complete quality assurance reviews on each report (file reviews and evaluations), letter, and appendix and provide clear and concise edits to the specialist, ensuring that reports and case documents are error free and delivered on time to the customer
• Review for consistency and clarity of content
• Ensure network specialist answers all questions requested by customer
• Review completeness of all reports, letters, and appendices, ensuring that all customer instructions were followed by the network specialist
• Identify potential clinical content inconsistencies and collaborate with Clinical Manager, Quality Assurance, and/or Clinical Subject Matter Experts as needed, including clarification reports
• Facilitate and document panel calls between network specialists as needed
• Send letters to attending physicians via fax or mail
• Send finalized reports and case documents to customers

§ Identify network panelist quality issues and resolve issues by providing feedback/training to the network panelist and, if necessary, referring the network panelist back to the Training Department based on available data

• Demonstrate proficiency in using R3 Continuum’s online portal [eCase Manager (eCM)] as it relates to QA tasks
• Document all communications with network specialists and work completed in eCM
• Monitor workload through use of eCM reports
• Maintain confidentiality utilizing HIPAA guidelines

Secondary Functions

• Assist in gathering case documents for legal records requests, as needed
• Participate in process improvement identification and solutions, including completion of special projects
• Participate in department and company meetings, as requested
• Perform other duties as assigned
• Overtime/Additional Hours – There are times in which overtime/additional hours will be mandatory due to an increase in work and the need to meet turnaround timeframes