Job Description

Job Description

Job Title : Clinical Quality Reviewer - Hybrid

Location : New York, NY 10004

Duration : 7 Months

Education : High School/GED

Shift Details : 9:00 AM -5:00 PM

Specific Skills :

• Maintain knowledge of medical record review and EMR systems.
• Stay current on HEDIS, QARR, and Star measure specifications.
• Distribute requests for records and schedule appointments with provider offices to ensure timely completion.
• Perform clinical audits via EMR, in-house paper records, and on-site provider visits to collect documentation of measure compliance.
• Accurately enter audit findings in the appropriate systems, ensuring documentation integrity and compliance standards.
• Clinical background: Health Educator, LPN, RN, LMSW, or LCSW
• Minimum 2 years of HEDIS review experience in a managed care or health plan setting
• Experience with medical record review for HEDIS/QARR measures

Licensure/Certification Required: Health Educator, LPN, RN, LMSW, or LCSW with ≥2 years HEDIS review experience

General Description:

We are seeking for a Clinical Quality Reviewer – Seasonal to perform medical record audits for compliance with HEDIS, QARR, and Medicare Advantage Star specifications. This role is critical to our annual Medical Record Review project

Job Tags

Similar Jobs