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

RTRJbU5ZSFZIbWplNkVDc1dmZG1VWTBPTGc9PQ==
  • ProKatchers LLC
  • New York, NY

Job Description

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

Vaco by Highspring

Senior Accountant Job at Vaco by Highspring

 ...Position Summary This Senior Accountant Consultant is responsible for applying established accounting principles and procedures to accurately...  ...& Expectations Minimum of 5 years of accounting experience in real estate, preferably property management Bachelors degree... 

Manpower

Warehouse Packer Job at Manpower

Manpower is seeking a dedicated Warehouse Packer to join our team, providing indispensable support in our distribution operations. As a leader in workforce solutions, Manpower understands the importance of placing great people in roles where they can excel. This position...

West Allis-West Milwaukee School District

Part-Time Reading Teacher Job at West Allis-West Milwaukee School District

 ...can live life on their own terms. The West Allis-West Milwaukee School District is currently seeking a part-time Elementary Reading Teacher at WAWM District. Candidates must have or be able to obtain a Wisconsin DPI-issued teaching license valid for Reading for the... 

CompHealth APP

Locum Tenens Physician Assistant - Critical Care/Intensive Care Job at CompHealth APP

 ...Job Description CompHealth APP is seeking a Physician Assistant Critical Care/Intensive Care for a locum tenens job in New Orleans, Louisiana...  ...locum tenens, travel opportunities, permanent hires, telemedicine and more, were able to achieve more success from every angle... 

Turner Staffing Group - Talent Board

Industrial Maintenance Mechanic Job at Turner Staffing Group - Talent Board

 ...Must have a minimum set of hand tools as specified by the Company. Previous experience must include a minimum of fours years in an apprentice program, preferably a millwright program. If the apprentice program is not a millwright program, then the job experience must...