Job DetailsJob Location: Norwood, MA 02062Position Type: Full TimeSalary Range: $27.00 - $31.25 HourlyTravel Percentage: NoneReady for Your Next Big Career Move? Use Your Clinical Expertise - All Without Leaving Home! Are you a Registered Nurse (RN) looking for a role that challenges you, supports your growth, and offers true work‑life balance? MES has an incredible opportunity that lets you make an impact from the comfort of your couch. We’re seeking a Clinical Quality Assurance Coordinator to join our team! In this role, you’ll ensure our Peer Review case reports consistently meet the highest standards of quality, accuracy, and compliance with client requirements, regulatory guidelines, and federal/state mandates. 100% Remote – Work where you’re most comfortable and productive. Meaningful Impact – Your expertise directly supports the integrity of our clinical review process. Flexible Schedule - Monday through Friday with rotating (approximately every 4 weeks) weekends. Three days of 8:00am-4:30pm EST and two days of 12:00pm-8:30pm EST (One of which is Friday) Responsibilities include: Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews. Ensure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations. Ensure that all client instructions and specifications have been followed and that all questions have been addressed. Ensure 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. Ensure the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards. Ensure the appropriate board specialty has reviewed the case in compliance with client specifications or state mandates and is documented accurately on the case report. Verify that the peer reviewer has attested to only the facts and that no evidence of reviewer conflict of interest exists. Ensure the provider credentials and signature are adhered to the final report. Identify any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed. Assist in resolution of client complaints and quality assurance issues as needed. Ensure all federal ERISA and state mandates are adhered to at all times. Provide 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. QualificationsHigh 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. 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. MES Solutions is a premier provider of independent medical examination and peer review services to the insurance, corporate, legal, and government sectors. Members of our credentialed medical panel conduct physical examinations or medical record reviews, delivering reports that assist clients in the resolution of automotive, disability, liability, and workers' compensation claims. MES has been providing services nationally since 1978 in accordance with the industry's highest standards of operating excellence and regulatory compliance. MES offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k. 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.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Utilization Management LVN supports the UM team by conducting medical necessity reviews, coordinating authorizations, and ensuring appropriate utilization of healthcare services in accordance with established guidelines. This role requires strong clinical judgment, attention to detail, and excellent communication skills to effectively collaborate with providers, members, and internal teams. - Conduct prospective, concurrent, and retrospective reviews to determine medical necessity and appropriateness of care - Apply established criteria such as MCG or InterQual to assess clinical documentation - Assist with processing prior authorization requests and determining level of care - Collaborate with RNs, physicians, and other clinical staff to ensure coordinated, timely reviews - Communicate determinations to providers and members in a timely and professional manner - Maintain accurate documentation of clinical reviews, determinations, and communications in the system - Identify and escalate cases that do not meet criteria to the appropriate clinical reviewer - Ensure compliance with regulatory and accreditation standards including NCQA, CMS, and state-specific guidelines - Participate in team meetings, trainings, and audits to ensure quality and consistency - Support special projects or initiatives as assigned by leadership Qualifications - Active and unrestricted LVN license in an eNLC (Enhanced Nurse Licensure Compact) state with multistate privileges - 3+ years of Nursing experience - 1+ years of Utilization Management experience - Familiarity with medical terminology, utilization management guidelines, and clinical documentation standards - Proficiency in Microsoft Office and experience working with healthcare systems or electronic medical records - Strong organizational and time management skills with the ability to work independently - Excellent written and verbal communication skills Requirements - Base Pay: up to $35 per hour - Pay frequency: Weekly pay - Training Schedule: 2 weeks, Monday – Friday; 8:00 AM - 5:00 PM CST - Production Schedule: Monday – Friday; 8:00 AM - 5:00 PM CST Benefits - Medical, Dental, and Vision coverage - Life Insurance - Short-Term and Long-Term Disability options - Flexible Spending Account (FSA) - Employee Assistance Program - 401(k) with employer contribution - Paid Time Off (PTO) - Tuition Reimbursement Company Description Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Skagit Radiology, Inc. / North Star Radiology is seeking board-certified or board-eligible Radiologists to join our collaborative, forward-thinking team in beautiful Washington State and Alaska. This is a shareholder-track opportunity with a clearly defined path to partnership, remote flexibility, and a supportive infrastructure built for physician success. - All subspecialties are being considered; positions are 80% subspecialized. - Lucrative, remote internal teleradiology moonlighting is available on your days off. - Both shareholder-track (1-year) and employee positions are available. Qualifications - Board-certified or board-eligible Radiologists. Requirements - Ability to work in a collaborative and forward-thinking environment. Benefits - For W-2 Employee Physicians: - Competitive compensation model. - 401(k) with immediate eligibility and employer match. - Comprehensive benefits package including medical, dental, vision. - CME allowance and full coverage of licensure fees. - Malpractice insurance coverage. - Paid time off. - For 1099 Independent Contractor Physicians: - Competitive compensation structure. - Flexible scheduling aligned with block preferences. - Malpractice coverage. - Ability to tailor workload and schedule. - Final structure (W-2 or 1099) may be adjusted based on candidate preference and practice needs. Company Description Skagit Radiology is a physician-owned practice committed to clinical excellence, operational stability, and collegial collaboration. With deep community roots and a reputation for quality, we provide high-level imaging services while maintaining a supportive and innovative environment for our physicians.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Skagit Radiology, Inc. / North Star Radiology is seeking board-certified or board-eligible Radiologists to join our collaborative, forward-thinking team in beautiful Washington State and Alaska. This is a shareholder-track opportunity with a clearly defined path to partnership, remote flexibility, and a supportive infrastructure built for physician success. - All subspecialties are being considered; positions are 80% subspecialized. - Lucrative, remote internal teleradiology moonlighting is available on your days off. - Both shareholder-track (1-year) and employee positions are available. Qualifications - Board-certified or board-eligible Radiologists. Requirements - Physician-owned and led practice. - Long-standing hospital and clinic partnerships across Washington State and Alaska. - Modern workflow and strong administrative support. - Technology-enabled remote environment. - Culture focused on physician autonomy, stability, and long-term success. - Predictable shift window with flexibility in how weeks are structured. - Designed to support true work-life balance. Benefits For W-2 Employee Physicians: - Competitive compensation model. - 401(k) with immediate eligibility and employer match. - Comprehensive benefits package including medical, dental, vision. - CME allowance and full coverage of licensure fees. - Malpractice insurance coverage. - Paid time off. For 1099 Independent Contractor Physicians: - Competitive compensation structure. - Flexible scheduling aligned with block preferences. - Malpractice coverage. - Ability to tailor workload and schedule. Final structure (W-2 or 1099) may be adjusted based on candidate preference and practice needs. Company Description Skagit Radiology is a physician-owned practice committed to clinical excellence, operational stability, and collegial collaboration. With deep community roots and a reputation for quality, we provide high-level imaging services while maintaining a supportive and innovative environment for our physicians.