Clinical Quality Reviewer Job at ProKatchers LLC, New York, NY

bW5pZTVTeGRLLzNGZXM0Nnk1UmJCNEpqM1E9PQ==
  • ProKatchers LLC
  • New York, NY

Job Description

Job Title : Clinical Quality Reviewer - Hybrid

Location : New York, NY 10004

Duration : 7 Months

Education : High School/GED

Shift Details : 9:00 AM -5:00 PM

Specific Skills :

  • Maintain knowledge of medical record review and EMR systems.
  • Stay current on HEDIS, QARR, and Star measure specifications.
  • Distribute requests for records and schedule appointments with provider offices to ensure timely completion.
  • Perform clinical audits via EMR, in-house paper records, and on-site provider visits to collect documentation of measure compliance.
  • Accurately enter audit findings in the appropriate systems, ensuring documentation integrity and compliance standards.
  • Clinical background: Health Educator, LPN, RN, LMSW, or LCSW
  • Minimum 2 years of HEDIS review experience in a managed care or health plan setting
  • Experience with medical record review for HEDIS/QARR measures

Licensure/Certification Required: Health Educator, LPN, RN, LMSW, or LCSW with ≥2 years HEDIS review experience

General Description:

We are seeking for a Clinical Quality Reviewer – Seasonal to perform medical record audits for compliance with HEDIS, QARR, and Medicare Advantage Star specifications. This role is critical to our annual Medical Record Review project

Job Tags

Seasonal work, Shift work,

Similar Jobs

Archdiocese of Detroit

Building Maintenance Technician Job at Archdiocese of Detroit

 ...Director of Parish Support Services (Business Manager) and the Pastor, with a dotted line reporting to the school Principal, the building maintenance technician is responsible for the effective, efficient, and safe maintenance, renovation and upkeep of the parish buildings... 

Penn State Health

Manager Integrated Radiology - Patient Access Job at Penn State Health

 ...pennstatehealth.psu.edu) SUMMARY OF POSITION: Responsible for managing the functions and staff required for the timely and accurate...  ..., pre-registration and pre-certification of all non-invasive radiological procedures across Penn State Health. Also responsible for... 

TransPerfect

Spanish Interpreter Job at TransPerfect

About the Company : TransPerfect Connect (TPC) is the worlds leading provider of interpreting services, including Over-the-Phone Interpretation (OPI) and Video Remote Interpretation (VRI). We support communication in over 170 languages and are committed to upholding ...

URBAN HEALTH PLAN, INC.

Licensed Clinical Social Worker Job at URBAN HEALTH PLAN, INC.

 ...Summary: We are seeking Clinical Social Worker III's (LCSW) to work within our VIDA...  ...members to assist with understanding and supporting patients. Engages in crisis intervention...  ...and refers patients or family to community resources. Provides consultation to medical... 

Maxim Crane Works, LP

Contract Reviewer Job at Maxim Crane Works, LP

Summary: The Contract Reviewer will review, revise, negotiate and finalize customer contracts as well as revisions suggested to Maxim Crane standard agreements. The successful candidate must have a meticulous nature suited to reading for the majority of each workday...