Manager of Clinical Quality

A nonprofit manager care organization is looking for an experienced RN to join their staff as the new Manager of Clinical Quality. The hired nursing professional will be responsible for leading both clinical and non-clinical staff charged with ensuring that the organization's members achieve the highest levels of clinical quality, as measured by HEDIS/QARR and STARS.

Nonprofit Managed Care Organization

The Manager of Clinical Quality is responsible for:

• Leading and/or participating in interactions with network hospitals and large provider groups
• Preparing and monitoring provider-specific HEDIS report cards
• Identifying areas of opportunity and discussing with hospital and/or provider contacts
• Maintaining medical records department contacts, and knowledge of medical record/ EMR systems
• Facilitating, leading and attending any provider education sessions or other initiative meetings (studies, partnerships) that involve targeted providers and/or measures
• Partnering/collaborating with network management representatives in support of provider engagement activities
• Managing the retrieval, collection and abstraction of medical records to support reporting of HEDIS and STARS measures
• Ensuring that records are collected timely and accurately from providers, while maintaining appropriate HIPAA Privacy and Security standards
• Taking lead in medical record audit and over-read processes
• Working with other NY managers and other staff within Clinical Performance Management (CPM) to develop, drive and implement interventions and programs

• 3+ years management experience in HEDIS/QARR
• 3+ years of Medicare experience
• RN license
• BS in related field
• Excellent communication skills
• Strong attention to detail

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