Remote role but will need to go to Newark, NJ to pick up equipment and orientation one day
General Information
This position is responsible for conducting quality audits for state audits, HEDIS and quality referral and complaints issues. This position is also responsible for preparing weekly, monthly, quarterly and year-end reports.
Responsibilities:
1. Conducts on-site reviews at participating provider offices to assess environment, quality of physicians medical records, and compliance with documentation standards.
2. Prepares appropriate documentation to summarize on-site findings with physician, providing education and discussing opportunities for improvement.
3. Provides data support services to facilitate the process and analyze trends/patterns for quality improvement and health management.
4. Assists the Quality Management department with various special projects and focused clinical studies.
5. Performs related tasks or special studies as requested.
6. Assists in training of internal Health staff, providers and vendors on programs and audit standards, both on and off site.
7. In-house representative and project lead for state audits.
8. Responsible for analysis of audit findings.
9. Produces various reports as requested.
10. Co-ordinates and manages the Corrective Action Plan (CAP) process for assigned audit type
11. Conducts reaudits ensuring prior deficiencies were addressed.
1. Requires three + years related business experience, preferably health care industry.
2. Requires License Practical Nurse License or an active New Jersey Registered Nurse License.
1. Requires knowledge of managed care principles.
2. Requires knowledge of medical terminology.
3. Requires knowledge of PC's and related software.
4. Prefers knowledge of URAC accreditation standards and HEDIS principles.
5. Prefers knowledge of health management or patient education.
...best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will...
...Alignment Health is seeking an inpatient review nurse to join the remote utilization management team.You will assist patients through the continuum of care in collaboration with the patients primary care physician, facility case manager, discharge planner and contracted...
...discounts Paid time off About the Role: Join Keema Salon as an Assistant and be a vital part of our dynamic team in Burr Ridge, IL! This... .... Responsibilities: Assist stylists with various hair services and treatments. Maintain cleanliness and organization...
...Dining Hall Worker $18.40$18.80/hour Ann Arbor, MI choose your own hours Upshift is hiring Dining Hall Workers for the dining halls... ...; we schedule you on the shifts you choose. About the job - Serve guests at hot and cold stations, keep lines stocked and presentable...
...Job Description Job Description Job Summary: The Fire Inspector/Technician is responsible for the proper installation, operation, and maintenance of various fire protection systems. Responsibilities include inspecting, testing, and performing system checks. This...