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Clinical Quality Manager
Healthfirst
- Saint Paul, Illinois, United States
- Saint Paul, Illinois, United States
Über
Reviews billing codes, medical records, and claims submission process to ensure accuracy
Attends and facilitates any initiative meetings (studies, partnerships) that involve targeted providers and/or measures.
Completes on-site visits on a regular basis to implement the work plan and to 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 in relation to HEDIS, QARR, Medicare Advantage and/or health promotions for HF newsletter.
Supports regulatory affairs, as deemed necessary by management.
Documents all relevant interactions in appropriate systems
Additional duties as assigned
Minimum Qualifications
Associates degree from an accredited institution
Ability to travel around the NYC metro area
Preferred Qualifications
Bachelors 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
Compliance & Regulatory Responsibilities:
Noted above
License/Certification: N/A
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
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Sprachkenntnisse
- English
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