RiverSpring Living
Clinical Quality Coordinator - Managed Long Term Care (MLTC) - Immediate Opportunity
Join Our Team as an Clinical Quality Coordinator at RiverSpring Health Plans!
Do you have a passion for caring for older adults? If so, you've found the perfect place to advance your career! Join our compassionate and dedicated team and make a meaningful difference in the lives of our members.
RiverSpring Health Plans serves over 18,000 frail and disabled individuals, empowering them to live independently in their homes for as long as possible.
The Clinical Quality Coordinator supports quality assurance and performance improvement activities including, but not limited to, analyzing clinical data to identify trends and opportunities, recommending improvements and serving as a subject matter expert for the organization. The position is responsible processing all Appeals within the Regulatory Timelines including Verbal and Written notifications and investigating clinical grievances and quality of care concerns for all RiverSpring Health Plans product lines. Coordinates with RiverSpring Health Plans' staff to ensure the completion and submission of documents related to grievance, appeal, incident and quality improvement activities within regulatory guidelines. Collaborates with Quality and IT staff in the analysis of clinical data. The Clinical Quality Coordinator reports to the Quality Assurance Manager or Assistant Vice President of Quality.
Qualifications: Bachelor's Degree in a nursing required Current valid New York State license as Registered Professional Nurse Minimum of two years in managed care setting. Care Management, Quality, Utilization Management and/or Grievance and Appeals experience. Demonstrated knowledge of Medicare and Medicaid regulations. Strong analytical skills. Effective oral and written communication skills. Strong organizational skills. Thorough knowledge of personal computer, especially proficiency with Microsoft Word, PowerPoint, and Excel. Ability to work and manage problems independently. Compensation:
Annual salary: $113,000 - $118,000 Benefits include health insurance, retirement plans, paid time off, and professional development opportunities
If you're ready to make a significant impact in the lives of older adults and support their wound care needs, we would love to hear from you!
Equal Opportunity Employer (EOE)
Join Our Team as an Clinical Quality Coordinator at RiverSpring Health Plans!
Do you have a passion for caring for older adults? If so, you've found the perfect place to advance your career! Join our compassionate and dedicated team and make a meaningful difference in the lives of our members.
RiverSpring Health Plans serves over 18,000 frail and disabled individuals, empowering them to live independently in their homes for as long as possible.
The Clinical Quality Coordinator supports quality assurance and performance improvement activities including, but not limited to, analyzing clinical data to identify trends and opportunities, recommending improvements and serving as a subject matter expert for the organization. The position is responsible processing all Appeals within the Regulatory Timelines including Verbal and Written notifications and investigating clinical grievances and quality of care concerns for all RiverSpring Health Plans product lines. Coordinates with RiverSpring Health Plans' staff to ensure the completion and submission of documents related to grievance, appeal, incident and quality improvement activities within regulatory guidelines. Collaborates with Quality and IT staff in the analysis of clinical data. The Clinical Quality Coordinator reports to the Quality Assurance Manager or Assistant Vice President of Quality.
Qualifications: Bachelor's Degree in a nursing required Current valid New York State license as Registered Professional Nurse Minimum of two years in managed care setting. Care Management, Quality, Utilization Management and/or Grievance and Appeals experience. Demonstrated knowledge of Medicare and Medicaid regulations. Strong analytical skills. Effective oral and written communication skills. Strong organizational skills. Thorough knowledge of personal computer, especially proficiency with Microsoft Word, PowerPoint, and Excel. Ability to work and manage problems independently. Compensation:
Annual salary: $113,000 - $118,000 Benefits include health insurance, retirement plans, paid time off, and professional development opportunities
If you're ready to make a significant impact in the lives of older adults and support their wound care needs, we would love to hear from you!
Equal Opportunity Employer (EOE)