Clinical Quality Reviewer Job at ProKatchers LLC, New York, NY

eTJ4N0cxenlnSGREeFV3cnF5RzFBOThPRFE9PQ==
  • ProKatchers LLC
  • New York, NY

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

Seasonal work, Shift work,

Similar Jobs

University of Minnesota

DOVE Predoctoral Excellence in Teaching Scholar Program (2026-2027 Academic Year Job at University of Minnesota

 ...Jobs Email this Job About the Job DOVE Predoctoral Excellence in Teaching Scholar Program (2026-2027 Academic Year) University of...  ...Graduate Labor Union-United Electrical, Radio and Machine Workers of America (GLU-UE). Award Components: 50% Graduate Assistantship - (Fall... 

Adecco

Document Processor - Lockbox Associate Job at Adecco

 ...Job Description Job Description Adecco is looking to hire Document Processors to work on assignments at our client Citigroup, or one of its affiliates. This is a long-term opportunity that could go Temp to Hire for star performers!! This job is performed in a... 

Red Bull

Distribution Analyst Job at Red Bull

 ...Distribution Analyst The Distribution Analyst is accountable for conducting analyses and providing support to Red Bull North America's (RBNA) Off-Premise Distribution team. The primary responsibilities of this role include leading the collection, evaluation, development... 

USAA

Manager, Claims Operations - Auto Non Injury Core and Express Job at USAA

 ...Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career... 

Tenet-AZ Region

Level II - Medical Lab Technician Job at Tenet-AZ Region

 ...Job Description Tenet-AZ Region is seeking a Medical Lab Technician Level II for a job in Tucson, Arizona. Job Description & Requirements ~ Specialty: Medical Lab Technician ~ Discipline: Allied Health Professional ~ Duration: Ongoing ~40 hours per week...