Quality Review Specialist
The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.
This position is responsible for quality assurance, accuracy and overall integrity of the care management records and documentation completed by Care Management staff. This role is to ensure compliance with NYS DOH and CMS regulations through development of auditing tools, specifically validating all data collected. Analyzes collected audit data, identify trends for staff re-training and implementing corrective action plans in collaboration with Clinical management staff. Provides support to Directors, Managers and Supervisors to insure that all documentation and reporting requirements are prepared and maintained in a professional and well-coordinated manner. This position is responsible for reviewing, collecting and preparing evidence packets for all scheduled Fair Hearings. managed care nurse, managed care rn, nursing, rn, nurse, care management
We truly value our staff and further acknowledge their contributions by offering:
We are an equal opportunity employer M/F/D/V.