HEDIS & Medicare Quality Manager

HealthFirst; New York (NY); On-site; USD 83,000 - 120,000; Full time

Job summary

Healthfirst is seeking a Clinical Quality Manager to lead quality initiatives focused on HEDIS, QARR, and Medicare Advantage Star measures. You will work with providers, members, and internal teams to improve care quality and monitoring progress.

The role requires an associate degree with travel across the NYC metro area; a bachelor’s degree and a clinical license are preferred, along with HEDIS experience in Medicaid and Medicare. Strong analytical and communication skills are essential.

Qualifications

• Associates degree required; travel in NYC metro area.
• Clinical license preferred: LPN, RN, LMSW or LCSW.
• HEDIS review experience for Medicaid and Medicare.
• Medical record review experience with HEDIS/QARR in managed care.
• Strong presentation and analytical skills.
• Intermediate MS Word, Excel and PowerPoint.
• Compliance & Regulatory responsibilities as noted above.

Responsibilities

• Interact with hospitals, providers, and members to improve quality of care and monitor progress.
• Review billing codes, medical records, and claims submission processes for accuracy.
• Attend initiative meetings involving targeted providers and measures.
• Conduct on-site provider visits and educate on coding practices and chart documentation.
• Collaborate with departments to maximize outreach for preventive services and chronic disease management.
• Assist in writing member/provider articles on HEDIS, QARR and Medicare Advantage.

Skills

HEDIS knowledge

Data analysis

Presentation skills

Relationship management

Analytical skills

Education

Associate’s degree

Bachelor’s degree

Clinical license: LPN/RN/LMSW/LCSW

Job description

Healthfirst is seeking a Clinical Quality Manager to lead quality initiatives focused on HEDIS, QARR, and Medicare Advantage Star measures. You will work with providers, members, and internal teams to improve care quality and monitoring progress.

The role requires an associate degree with travel across the NYC metro area; a bachelor’s degree and a clinical license are preferred, along with HEDIS experience in Medicaid and Medicare. Strong analytical and communication skills are essential.