Network ESC A Division of Network Temps, Inc.
Clinical Quality Reviewer
Network ESC A Division of Network Temps, Inc., New York, New York, us, 10261
TOP HEALTH INSURANCE COMPANY NOW HIRING CLINICAL QUALITY REVIEWER
Located in Manhattan, NY. Paying $63 an hour.
Position Overview The primary function of the Clinical Quality Reviewer – Seasonal is to conduct audits of medical charts for compliance with HEDIS, QARR, and Medicare Advantage Star measure specifications. This position will be an integral part of the annual Medical Record Review project required to report HEDIS/QARR measures to the NYS Department of Health and Centers for Medicare & Medicaid Services (CMS). The role may require travel within the five boroughs.
Scope of Role & Responsibilities Maintain knowledge of medical record review and EMR systems; keep up-to-date on HEDIS, QARR, and Star specifications; distribute requests for records and schedule appointments with provider offices to ensure timely completion of duties; perform clinical audits via EMR, in‑house paper medical records, and on‑site provider visits to collect documentation of measure compliance; enter accurate and timely findings in the appropriate system(s) in accordance with established documentation standards to ensure integrity of member services over the continuum of care.
Required Education, Training & Professional Experience Clinical background: Health Educator, LPN, RN, LMSW, or LCSW with a minimum of two years HEDIS review experience.
Experience with medical record review working on HEDIS/QARR in a managed care or health plan setting.
Proficient in Microsoft Office applications including Word, Excel, PowerPoint, and Access.
Licensure and/or Certification Required
Clinical background: Health Educator, LPN, RN, LMSW, or LCSW with a minimum of two years HEDIS review experience.
#J-18808-Ljbffr
Position Overview The primary function of the Clinical Quality Reviewer – Seasonal is to conduct audits of medical charts for compliance with HEDIS, QARR, and Medicare Advantage Star measure specifications. This position will be an integral part of the annual Medical Record Review project required to report HEDIS/QARR measures to the NYS Department of Health and Centers for Medicare & Medicaid Services (CMS). The role may require travel within the five boroughs.
Scope of Role & Responsibilities Maintain knowledge of medical record review and EMR systems; keep up-to-date on HEDIS, QARR, and Star specifications; distribute requests for records and schedule appointments with provider offices to ensure timely completion of duties; perform clinical audits via EMR, in‑house paper medical records, and on‑site provider visits to collect documentation of measure compliance; enter accurate and timely findings in the appropriate system(s) in accordance with established documentation standards to ensure integrity of member services over the continuum of care.
Required Education, Training & Professional Experience Clinical background: Health Educator, LPN, RN, LMSW, or LCSW with a minimum of two years HEDIS review experience.
Experience with medical record review working on HEDIS/QARR in a managed care or health plan setting.
Proficient in Microsoft Office applications including Word, Excel, PowerPoint, and Access.
Licensure and/or Certification Required
Clinical background: Health Educator, LPN, RN, LMSW, or LCSW with a minimum of two years HEDIS review experience.
#J-18808-Ljbffr