Clinical Quality Manager
100 CHURCH STREETJob$73–108K/yrSeen 1 day agoSeen in employer's feed 1 day ago
Most applications go out cold — see where you stand first. No sign-up to start.
Watch jobs like this. New roles like this one near 100 CHURCH STREET, by email.
Don't just apply. Show up ready.
Olive works from this exact posting.
At a glance
Olive lists jobs from US employers, including remote roles you can work from the United States.
Requirements
Credentials this posting asks for.
Job overview
The Clinical Quality Manager works with hospitals, providers, and members to improve care quality and monitor progress. The role reviews billing codes, medical records, and claims processes; conducts provider visits and education; and collaborates on preventive services and chronic disease management. It also supports quality-related meetings, member and provider communications, regulatory affairs, and documentation. An associate degree is required; a bachelor’s degree, clinical license, and relevant HEDIS experience are preferred.
Skills & qualifications
Skills
Qualifications
Benefits
Full job description
Duties & 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
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
Hiring Range*:
Greater New York City Area (NY, NJ, CT residents): $83,100 - $118,560
All Other Locations (within approved locations): $73,400 - $108,160
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.
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.
You've read the whole posting — now see how you match it.