Swoon ยท 3 weeks ago
Healthcare Quality Reviewer
New York, NY
Contract
Onsite
Entry, Mid Level
$60/hr - $70/hr
2+ years expSwoon is seeking a Clinical Quality Reviewer - Seasonal to conduct audits of medical charts for compliance with HEDIS, QARR, and Medicare Advantage Star measure specifications. This role will be essential for the annual Medical Record Review project and requires knowledge of medical record review and EMR systems.
ConsultingHuman ResourcesInformation TechnologyLegalStaffing Agency
Hiring Manager
Conor Cronin
Responsibilities
Maintain knowledge of medical record review and EMR systems
Maintain up-to-date knowledge of HEDIS, QARR and Star specifications
Distribute requests for records and schedules appointments with provider offices to ensure timely completion of duties to meet internal and regulatory standards and requirements
Perform clinical audits via EMR, in-house paper medical records, on-site provider visits to collect documentation of measure compliance
Data enter accurate and timely findings in the appropriate system(s) in accordance with established documentation standards for MetroPlus Health Plan to ensure integrity of member services provided over the continuum of care and over time
Qualification
Required
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
Company
Swoon
In 2010, Swoon launched an agile, client-focused team that is not only savvy in our core industries but elbow-deep, every day, getting to know the strongest talent in the technology and professional fields.
501-1000 employees
H1B Sponsorship
Swoon has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2023 (2)
2022 (1)
2021 (1)
2020 (1)
Funding
Current Stage
Late StageLeadership Team
Andy Baker
Co-Founder and Leadership Advisor
Alyssa Holtz
Client Partner
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