Clinical Quality Investigator

USFHP; New York (NY); Híbrido; USD 80.000 - 115.000; Jornada completa

Descripción de la vacante

USFHP in Manhattan, NY is seeking a Clinical Quality Reviewer (hybrid) to oversee post-service clinical reviews across care settings. The role emphasizes adherence to standards of care, data-driven analysis, and timely issue resolution under the Quality Management department.

The ideal candidate holds an RN or LPN/LVN license with 1–3 years in quality management and strong MS Office skills. You will collaborate with internal teams and vendors to improve beneficiary services while maintaining

Formación

• RN or LPN/LVN license required.
• 1-3 years of healthcare quality management experience.
• Ability to read and abstract medical records and data.
• Strong analytical and problem-solving skills.
• Proficiency with Microsoft Office tools (Excel, Word, PowerPoint).

Responsabilidades

• Conduct post-service clinical reviews and document findings.
• Perform literature reviews and summarize findings.
• Contact providers to obtain medical records for reviews.
• Chart reviews and data abstraction for audits and investigations.
• Prepare concise investigative summaries and letters.
• Collaborate with stakeholders and maintain confidentiality.
• Meet deadlines and report quality issues promptly.

Conocimientos

Healthcare quality management

Nursing experience

Analytical skills

Communication skills

Data analysis

Educación

RN or LPN/LVN licensed

BA/BS or BSN preferred

Herramientas

Excel

Outlook

PowerPoint

Word

Access

Descripción del empleo

USFHP in Manhattan, NY is seeking a Clinical Quality Reviewer (hybrid) to oversee post-service clinical reviews across care settings. The role emphasizes adherence to standards of care, data-driven analysis, and timely issue resolution under the Quality Management department.

The ideal candidate holds an RN or LPN/LVN license with 1–3 years in quality management and strong MS Office skills. You will collaborate with internal teams and vendors to improve beneficiary services while maintaining