Clinical Quality Manager Healthfirst

• 2.0 New York, NY Job Details Full-time $83,100
• $120,360 a year 1 hour ago Benefits Health insurance Dental insurance 401(k) Vision insurance Life insurance Qualifications Collaborate with healthcare professionals Quality control experience within healthcare industry Medical claims processing Medicare Quality of care (regulatory compliance area) Health education for healthcare providers Medical billing and coding coordination with healthcare providers Medical billing compliance checks Care documentation Mid-level Charge capture (medical billing) Medicare regulations Health record chart audits Regulatory affairs Continuous clinical improvement initiatives Meeting facilitation Patient progress monitoring Progress documentation Healthcare claims compliance audits Healthcare coding investigations Regulatory compliance management Documentation reviews Quality assurance experience within healthcare Full Job Description The Clinical Quality Manager 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

• Interacts with hospitals, providers, and members to improve quality of care, monitor progress, and recommend changes
• Reviews billing codes, medical records, and claims submission process to ensure accuracy
• Attends and facilitates any initiative meetings (studies, partnerships) that involve targeted providers and/or measures.
• Completes on-site visits on a regular basis to implement the work plan and to 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 in relation to HEDIS, QARR, Medicare Advantage and/or health promotions for HF newsletter.
• Supports regulatory affairs, as deemed necessary by management.
• Documents all relevant interactions in appropriate systems
• Additional duties as assigned Hiring Range
• : Greater New York City Area (NY, NJ, CT residents): $83,100
• $120,360 All Other Locations (within approved locations): $73,400
• $108,160 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. 73400-108160