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Clinical Quality Manager
| Company | Healthfirst |
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| Location | New York, NY, USA |
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| Salary | $71594 – $116480 |
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| Type | Full-Time |
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| Degrees | Bachelor’s, Associate’s |
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| Experience Level | Mid Level, Senior |
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Requirements
- Associate’s degree from an accredited institution
- Ability to travel around the NYC metro area
Responsibilities
- Interacts with hospitals, providers, and members to improve quality of care, monitor progress, and recommend changes
- Reviews billing codes, medical records, and claims submission processes to ensure accuracy
- Attends and facilitates any initiative meetings (studies, partnerships) that involve targeted providers and/or measures
- Completes on-site provider visits to implement work plans and conduct provider education sessions regarding appropriate coding practices and chart documentation
- Collaborates with other departments to maximize member outreach for preventive services and chronic disease management
- Assists in writing member and/or provider articles on HEDIS, QARR, Medicare Advantage, and/or health promotions for the HF newsletter
- Assists and supports regulatory affairs
- Document all relevant interactions in appropriate systems
- Additional duties as necessary
Preferred Qualifications
- Bachelor’s Degree from an accredited institution
- Clinical license: LPN, RN, LMSW or LCSW
- Multiple years of HEDIS review experience for both Medicaid and Medicare lines of business
- Medical record review experience directly working on HEDIS/QARR in a managed care setting
- Good presentation, relationship management, and analytical skills
- Intermediate MS Word, Excel, and PowerPoint
