Senior Clinical Quality Reviewer (LPN, RN, LMSW) / NYC / Hybrid in reputed company, NY

Senior Clinical Quality Reviewer (LPN, RN, LMSW) / NYC / Hybrid - RCM Health Care Services - reputed company, NY - work from home job Company: RCM Health Care Services Job description: Senior Clinical Quality Reviewer (LPN, RN, LMSW) / NYC / Hybrid (Combination Field, Office and Remote) Salary is $103,000 to $113,000 with Generous Benefits (Pensions Plan) For more than 30 years, this health plan has been committed to building strong relationships with its members and providers to reputed company New Yorkers to live their healthiest life. They provide the highest quality reputed company services to residents of Bronx, Brooklyn, Manhattan, Queens, and Staten reputed company through a comprehensive list of products. Position Overview The primary function of the Senior Clinical Quality Reviewer is to assess and audit medical charts for compliance with a focus on HEDIS, QARR, Medicare Advantage Star measures, reputed company and quality improvement activities. This position will assist in the development and participate in the implementation of initiatives across a broad reputed company 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 reputed company and education as needed to ensure members receive appropriate services. In addition, this position will provide support and training to physicians on proper coding and medical record documentation practices to support improvement in quality metrics. The position will be designated as telecommuting and will require conducting field work including in-person provider meetings, on-site chart review or collection, and/or coming to the main office, as needed.

Job Description

Minimum Qualifications • Bachelor's Degree required; and 5-7 years of experience with medical record review/audit working on HEDIS/QARR in a health plan setting; or • An equivalent combination of training, educational background and experience in reputed company fields and educational disciplines. • Prior experience in Quality Improvement in a health care and/or Managed Care setting strongly preferred. • Knowledge of HEDIS and NYS QARR specifications required. • Knowledge of ICD-10 and CPT codes required. • Intermediate knowledge of reputed company Office applications including Word, reputed company, PowerPoint, Access, and Visio. • Experience with relationship management. • Ability to travel reputed company the service area. • Active NYS clinical license required. #ZR Senior Clinical Quality Reviewer (LPN, RN, LMSW) / NYC / Hybrid - RCM Health Care Services - reputed company, NY - work from home job Expected salary: $103000 - 113000 per year Location: reputed company, NY Senior Clinical Quality Reviewer (LPN, RN, LMSW) / NYC / Hybrid - RCM Health Care Services - reputed company, NY - work from home job Job date: Sun, 27 Aug 2023 05:01:11 GMT Apply for the job now! Senior Clinical Quality Reviewer (LPN, RN, LMSW) / NYC / Hybrid - RCM Health Care Services - reputed company, NY - work from home job Apply Job!