Clinical Quality Reviewer - Integrated Resources, Inc
New York, NY 10004
About the Job
PR range:
Schedule Notes:
9-5 Hybrid
"Ability to travel within the MetroPlus service area
"3 5 years in Quality Improvement in a health care and/or Managed Care setting strongly preferred
"Clinical background: Health Educator, RN, LPN, RN, LMSW or LCSW, Foreign Medical Graduate (FMG) with a minimum of three years relevant work experience.
"Experience with medical record review working on HEDIS/QARR in a managed care or health plan setting.
Position Overview
The primary function of the Clinical Quality Reviewer is to assess and audit medical charts for compliance with a focus on HEDIS, QARR, Medicare Advantage Star measures and quality improvement activities. This position will assist in the development and participate in the implementation of initiatives across a broad array of clinical measures and health improvement activities. Quality audit findings from this position will contribute to the support and training of physicians on proper coding and medical record documentation practices to support improvement in quality metrics. As a result, this role will be required to conduct regular internal provider audits and then document, summarize and report findings. Additionally, participation in the annual HEDIS and QARR hybrid medical record review project will be required. This role may also participate in member outreach and education as needed to ensure members receive appropriate services.
Schedule Start Date:
09/30/2024
Schedule Start Date:
09/30/2024
Schedule Hours Per Week:
40.00
Schedule Hours Per Day:
8.00
Schedule Days Per Week:
5.00
- $35-$38/hr. on w2
Schedule Notes:
9-5 Hybrid
"Ability to travel within the MetroPlus service area
"3 5 years in Quality Improvement in a health care and/or Managed Care setting strongly preferred
"Clinical background: Health Educator, RN, LPN, RN, LMSW or LCSW, Foreign Medical Graduate (FMG) with a minimum of three years relevant work experience.
"Experience with medical record review working on HEDIS/QARR in a managed care or health plan setting.
Position Overview
The primary function of the Clinical Quality Reviewer is to assess and audit medical charts for compliance with a focus on HEDIS, QARR, Medicare Advantage Star measures and quality improvement activities. This position will assist in the development and participate in the implementation of initiatives across a broad array of clinical measures and health improvement activities. Quality audit findings from this position will contribute to the support and training of physicians on proper coding and medical record documentation practices to support improvement in quality metrics. As a result, this role will be required to conduct regular internal provider audits and then document, summarize and report findings. Additionally, participation in the annual HEDIS and QARR hybrid medical record review project will be required. This role may also participate in member outreach and education as needed to ensure members receive appropriate services.
Product of Role & Responsibilities |
|
Required Education, Training & Professional Experience |
|
Licensure and/or Certification Required |
|
Professional Competencies |
Integrity and Trust Customer Focus Functional/Technical skills Written/Oral Communication |
Schedule Start Date:
09/30/2024
Schedule Start Date:
09/30/2024
Schedule Hours Per Week:
40.00
Schedule Hours Per Day:
8.00
Schedule Days Per Week:
5.00
Source : Integrated Resources, Inc