Job Information
Healthfirst Clinical Quality Manager in Hybrid, New York
Job Description
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 assigned
Minimum Qualifications:
Ability to travel around the NYC metro area
Associates degree
Preferred Qualifications:
Bachelors Degree
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
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.