Clinical Quality Manager

Healthfirst; United States; Remote; USD 71,000 - 117,000; Full time

Job summary

This innovative firm is seeking a Clinical Quality Manager dedicated to enhancing the quality of care. In this role, you will collaborate with healthcare providers and members to ensure optimal service delivery, focusing on key quality measures like HEDIS and Medicare Advantage Stars. You will conduct on-site visits, facilitate educational sessions, and work closely with various departments to promote preventive services. If you are passionate about healthcare quality and have a strong background in clinical practices, this position offers a unique opportunity to make a significant impact in the community.

Benefits

Medical Coverage

Dental Coverage

Vision Coverage

Life Insurance

401k Contributions

Incentive Programs

Recognition Programs

Qualifications

• Associate's degree required; Bachelor's preferred with clinical license.
• Experience in HEDIS review and medical record review is essential.

Responsibilities

• Interact with providers and members to improve quality of care.
• Conduct provider education sessions on coding practices.

Skills

Analytical Skills

Relationship Management

Presentation Skills

HEDIS Review Experience

Medical Record Review

Education

Associate's Degree

Bachelor's Degree

Tools

MS Word

MS Excel

MS PowerPoint

Job description

The Clinical Quality Manager works with members and providers to ensure members receive appropriate services. This role emphasizes improving the quality of care with a focus on HEDIS, QARR and Medicare Advantage Star measures.

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:

• Associate’s degree from an accredited institution
• Ability to travel around the NYC metro area

Preferred Qualifications:

• Bachelor’s 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

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to 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.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [e-mail] or calling 212-519-1798. In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $81,099 - $116,480

• All Other Locations (within approved locations): $71,594 - $106,080

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.