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Quality Review Coordinator Jobs (NOW HIRING)

Birmingham

Quality Review Coordinator

Birmingham, AL · On-site

The Medical Review Unit develops, implements, and administers programs such as Medical Review and Preferred Medical Doctor, to determine medical necessity of services and impact cost savings.

Birmingham

Quality Review Coordinator

Birmingham, AL · On-site

The Medical Review Unit develops, implements, and administers programs such as Medical Review and Preferred Medical Doctor, to determine medical necessity of services and impact cost savings.

National Medical Reviews

Review Coordinator

Warminster, PA · On-site

$19.25 - $26/hr

Coordinates case review activities consistent with corporate policy and client-specific procedures ... Participates in quality improvement activities, as requested Education, Experience and Professional ...

National Medical Reviews

Review Coordinator

Warminster, PA · On-site

$19.25 - $26/hr

Coordinates case review activities consistent with corporate policy and client-specific procedures ... Participates in quality improvement activities, as requested Education, Experience and Professional ...

Ascension

Quality Peer Review Coordinator

Tulsa, OK · On-site

Improves patient safety by coordinating objective case reviews and identifying risks for proactive process improvements. * Delivers data-driven feedback to clinicians to support ongoing quality ...

Ascension

Quality Peer Review Coordinator

Tulsa, OK · On-site

$39.50/hr

Improves patient safety by coordinating objective case reviews and identifying risks for proactive process improvements. * Delivers data-driven feedback to clinicians to support ongoing quality ...

Axiom Care

Utilization Review Coordinator

Phoenix, AZ · On-site

Job Type Full-time Description The UR Coordinator's primary responsibility is managing, reviewing ... Participation with departmental staff in quality improvement meetings and projects. * Preparing ...

UHS

Utilization Review Coordinator

West Columbia, SC · On-site

... in quality behavioral health and substance abuse services for adolescents and adults. We offer a ... Coordinates the utilization management functions of a patient caseload through collaboration with ...

UHS

Utilization Review Coordinator

West Columbia, SC

... in quality behavioral health and substance abuse services for adolescents and adults. We offer a ... Coordinates the utilization management functions of a patient caseload through collaboration with ...

UHS

Utilization Review Coordinator

West Columbia, SC · On-site

... in quality behavioral health and substance abuse services for adolescents and adults. We offer a ... Coordinates the utilization management functions of a patient caseload through collaboration with ...

UHS

Utilization Review Coordinator

West Columbia, SC · On-site

... in quality behavioral health and substance abuse services for adolescents and adults. We offer a ... Coordinates the utilization management functions of a patient caseload through collaboration with ...

UHS

Utilization Review Coordinator

West Columbia, SC

... in quality behavioral health and substance abuse services for adolescents and adults. We offer a ... Coordinates the utilization management functions of a patient caseload through collaboration with ...

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How much do quality review coordinator jobs pay per hour?

As of Sep 2, 2026, the average hourly pay for quality review coordinator in the United States is $26.94, according to ZipRecruiter salary data. Most workers in this role earn between $20.19 and $31.25 per hour, depending on experience, location, and employer.

What is a quality review coordinator?

Quality Review Coordinators are professionals who oversee and assess the quality of products, services, or processes within an organization. They are responsible for ensuring that all standards and regulations are met, conducting audits and reviews, and identifying areas for improvement. Their work helps maintain compliance, improve efficiency, and support continuous quality improvement initiatives. Quality Review Coordinators often collaborate with various departments and provide feedback to help teams achieve quality objectives.

How does a quality review coordinator typically collaborate with other departments to ensure compliance and process improvements?

A Quality Review Coordinator often works closely with teams such as operations, compliance, and training to monitor adherence to company policies and regulatory standards. They regularly communicate findings from audits or quality assessments to relevant stakeholders and may participate in cross-functional meetings to address recurring issues or implement process enhancements. This role requires strong interpersonal skills to provide constructive feedback and facilitate teamwork, ultimately driving continuous improvement across the organization.

What are the key skills and qualifications needed to thrive as a quality review coordinator, and why are they important?

To thrive as a Quality Review Coordinator, you need a strong background in quality assurance, data analysis, and process improvement, often supported by a degree in a related field such as healthcare or business. Familiarity with quality management systems, audit tools, and relevant certifications like Six Sigma or CPHQ is typically required. Attention to detail, problem-solving ability, and effective communication are crucial soft skills for collaborating with teams and ensuring compliance. These competencies are essential for maintaining high standards, identifying improvement opportunities, and ensuring organizational effectiveness.
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Quality Review Coordinator jobs near you
Infographic showing various Quality Review Coordinator job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 13% Part Time, 4% Contract, and 1% Nights. Highlights an 86% Physical, 2% Hybrid, and 12% Remote job distribution, with an average salary of $56,028 per year, or $26.9 per hour.

Quality Review Coordinator

Birmingham

Birmingham, AL • On-site

Full-time

Re-posted 6 days ago

Job description

BASIC FUNCTION

Perform and administer level 2 Medical Review Pre-Determinations according to benefit language and standard medical care.

ENVIRONMENT

The Health Managed Department is responsible for developing, implementing and administering private business and government utilization review, medical review, cost containment, reconsiderations, and post payment audit programs to assure optimization of cost savings to the company regarding medical claims. The Medical Review Unit develops, implements, and administers programs such as Medical Review and Preferred Medical Doctor, to determine medical necessity of services and impact cost savings.

WORKFLOW

Work is received via fax or mail from providers, groups and subscribers. Incumbent performs reviews of proposed procedures to approve reimbursement or denial of services. Incumbent performs special projects to investigate propriety of PMD and claims and assures PMD guidelines are followed. Incumbent provides weekly reports on request activities. Incumbent prepares reconsideration case for Level III review. The incumbent creates allow or reject on each contract for which a decision has been rendered. The incumbent researches and suggests changes to guides according to the most recent scientific literature.

KNOWLEDGE

Incumbent must have a thorough understanding of medical practice that can be obtained through a nursing degree program or experience required to obtain Registration (RN) from the state. The incumbent must know claims payment guidelines, billing guidelines, laws and contracts that govern the health insurance program administered by this corporation. The incumbent must be able to discuss coverage guidelines and benefit issues with physicians, group administrators, or internal customers. The incumbent must be able to assist groups in benefit design within the parameters of cost and standard medical care.

THINKING REQUIREMENTS:

The incumbent must be an independent thinker and therefore able to work closely via personal, written or oral communication with representatives and officials of public, private and governmental agencies and professionals inside and outside the Corporation. These groups include the provider financial and medical representatives, customer representatives, and Blue Cross and Blue Shield representatives.

INTERFACES AND INTERPERSONAL SKILLS:

Incumbent has contact with groups, providers and their office representatives, subscribers and internal departments involved with Marketing and claims processing. This contact is usually one to one. However, it can be in the form of a presentation to large audiences. Frequently, the provider or subscriber is frustrated and angry and incumbent must be able to establish effective communications to resolve problems.

AUTHORITY AND DECISION MAKING:

Incumbent decides medical necessity of particular procedure in accordance to contract limits and standard medical practice, and resolves problems for subscribers, groups and providers. Incumbent represents Blue Cross and Blue Shield of Alabama when performing before a large group.

PRINCIPAL ACCOUNTABLITIES
  • Activity: Perform medical and utilization predeterminations of PMD and/or non-PMD providers both in state and out.
    End Result: To determine if coding is correct and procedures filed were medically necessary in order to control and reduce medical care costs.
  • Activity: Respond to telephone or written requests for information from Subscribers and providers.
    End Result: To provide requested information to solve claims problems
  • Activity: Perform special projects with requested guidelines
    End Result: To investigate costs associated with PMD to assure compliance with PMD guidelines.
  • Activity: Prepare dialogue and support materials for workshops thorugh the state, as directed, for groups, agencies or providers.
    End Result: To educate groups, providers, and subscribers in total program concepts.
  • Activity: Assist in the development of new preferred care programs and their guidelines.
    End Result: To expand health management products, control costs and reduce overall medical expenses.

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