Health First, Inc

Clinical Quality Manager

Health First, Inc • $83K — $120K *
New York, NY 10025In-Person
Healthcare
Less than 5 years of experience
Today
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Job Overview by Ladders

Qualifications

  • 5-7 years of experience in clinical quality management or related field
  • Strong knowledge of HEDIS, QARR, and Medicare Advantage Star measures
  • Excellent communication and interpersonal skills for stakeholder engagement
  • Proficiency in reviewing billing codes and medical records
  • Experience conducting provider education and outreach initiatives
  • Ability to analyze and document quality improvement data
  • Familiarity with regulatory requirements in healthcare.

Responsibilities

  • Interact with hospitals and providers to enhance care quality
  • Review billing codes and medical records for accuracy
  • Facilitate initiative meetings with targeted providers
  • Conduct regular on-site visits for education and implementation
  • Collaborate with other departments to improve member outreach
  • Draft articles related to quality measures for health promotions
  • Document interactions in relevant systems

Benefits

  • Medical, dental, and vision insurance
  • Incentive and recognition programs
  • Life insurance
  • 401k contributions
  • Comprehensive benefits package subject to eligibility requirements
Full Job Description
The Clinical Quality Manager with members and providers to ensure members receive appropriate services. This role emphasizes improving the quality of care with a focus on HEDIS, QARR and Medicare Advantage Star measures.

- Interacts with hospitals, providers, and members to improve quality of care, monitor progress, and recommend changes - Reviews billing codes, medical records, and claims submission process to ensure accuracy - Attends and facilitates any initiative meetings (studies, partnerships) that involve targeted providers and/or measures. - Completes on-site visits on a regular basis to implement the work plan and to conduct provider education sessions regarding appropriate coding practices and chart documentation. - Collaborates with other departments to maximize member outreach for preventive services and chronic disease management. - Assists in writing member and/or provider articles in relation to HEDIS, QARR, Medicare Advantage and/or health promotions for HF newsletter. - Supports regulatory affairs, as deemed necessary by management. - Documents all relevant interactions in appropriate systems - Additional duties as assigned

Hiring Range*:

  • Greater New York City Area (NY, NJ, CT residents): $83,100 - $120,360

  • All Other Locations (within approved locations): $73,400 - $108,160

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in 7ood faith8 would pay to a new hire, or for a job promotion, or transfer into this role.

About Health First, Inc

Learn more about Health First, Inc
Industry
Hospitals & Medical Centers
* Ladders Estimates

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