Innova Solutions is immediately hiring for HEDIS Clinical Quality Reviewer
Position type: Contract Duration: 6+ month Location: NYC- Hybrid - Manhattan.
The primary function of the Clinical Quality Reviewer is to assess and audit medical charts for compliance with a focus on HEDIS, QARR, Medicare Advantage Star measures and quality improvement activities. This position will assist in the development and participate in the implementation of initiatives across a broad array of clinical measures and health improvement activities. Quality audit findings from this position will contribute to the support and training of physicians on proper coding and medical record documentation practices to support improvement in quality metrics. As a result, this role will be required to conduct regular internal provider audits and then document, summarize and report findings. Additionally, participation in the annual HEDIS and QARR hybrid medical record review project will be required. This role may also participate in member outreach and education as needed to ensure members receive appropriate services.
Scope of Role & Responsibilities- Maintain knowledge of medical record review and EMR systems.
- Maintain up-to-date knowledge of HEDIS, QARR and Star specifications
- Distribute requests for records and schedules appointments with provider offices to ensure timely completion of duties to meet internal and regulatory standards and requirements.
- Perform clinical audits via EMR, in-house paper medical records, on-site provider visits to measure compliance with preventive health guidelines and to measure effectiveness of quality improvement initiatives.
- Identify, track and report variation from standards of care by audit of core operations, patient care processes and medical record documentation. Designs interventions to drive improvement and minimize variation from standards of care.
- Data enter accurate and timely clinical quality findings in the appropriate system(s) in accordance with established documentation standards for the Health Plan to ensure integrity of member services provided over the continuum of care and over time.
- Assist in implementation of quality improvement activities as directed by Quality Management programming needs. Support interdepartmental and internal teams focused on process improvement projects and outcomes.
- Provide educational support to physicians and staff to ensure process improvement and increase member satisfaction, member retention, continuity of care and drive HEDIS and QARR improvement activities.
- Facilitate retrieval of medical record documentation and work with provider group(s) and in-field navigators to retrieve electronic and paper records that supports HEDIS/QARR.
- Records findings of patient encounters to include patient identifiers, relevant information and results in database.
- Participate in the annual HEDIS and QARR hybrid medical record review project:
- Work with provider offices to facilitate request and review of charts
- Supports temporary staff in the review of medical records (electronic and paper-based)
- Serve as a final reviewer of HEDIS and QARR records
- Other duties as assigned by Quality Review Lead or QM Operations Director.
Required Education, Training & Professional Experience- MUST have Medical Assistant, Nursing Assistant, Health Educator, LPN, RN, LMSW or LCSW
- Need to have real reviewer experience and not retrieval.
- Clinical background: Health Educator, RN, LPN, RN, LMSW or LCSW, Foreign Medical Graduate (FMG) with a minimum of three years relevant work experience.
- Experience with medical record review working on HEDIS/QARR in a managed care or health plan setting.
- 3 – 5 years in Quality Improvement in a health care and/or Managed Care setting strongly preferred.
- Ability to travel within the service area.
- Knowledge of HEDIS and QARR specifications.
- Experience using EMR systems, e.g. EPIC, QuadraMed.
- Proficient in Microsoft Office applications including Word, Excel, PowerPoint and Access.
- Knowledge of ICD-10 and CPT codes preferred.
- Strong written and verbal presentation.
- Ability to proficiently read and interpret medical records; Ability to measure compliance and identify deficiencies in chart documentation against standards.
- Ability to work in a team setting and independently prioritize projects and assignments.
PAY RANGE AND BENEFITS: Pay Range*: $35-43/hr w2
*Pay range offered to a successful candidate will be based on several factors, including the candidate's education, work experience, work location, specific job duties, certifications, etc.
Benefits: Innova Solutions offers benefits( based on eligibility) that include the following: Medical & pharmacy coverage, Dental/vision insurance, 401(k), Health saving account (HSA) and Flexible spending account (FSA), Life Insurance, Pet Insurance, Short term and Long term Disability, Accident & Critical illness coverage, Pre-paid legal & ID theft protection, Sick time, and other types of paid leaves (as required by law), Employee Assistance Program (EAP).
ABOUT INNOVA SOLUTIONS:Founded in 1998 and headquartered in Atlanta, Georgia, Innova Solutions employs approximately 50,000 professionals worldwide and reports an annual revenue approaching $3 Billion. Through our global delivery centers across North America, Asia, and Europe, we deliver strategic technology and business transformation solutions to our clients, enabling them to operate as leaders within their fields
Website: https://www.innovasolutions.com/
Innova Solutions is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Innova Solutions is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race, color, religion or belief, national origin, citizenship, social or ethnic origin, sex, age, physical or mental disability, veteran status, marital status, domestic partner status, sexual orientation, or any other status protected by the statutes, rules, and regulations in the locations where it operates. If you are an individual with a disability and need a reasonable accommodation to assist with your job search or application for employment, please contact us at hr@innovasolutions.com or (770) 493-5588. Please indicate the specifics of the assistance needed. Innova Solutions encourages all interested and qualified candidates to apply for employment opportunities. Innova Solutions (HireGenics/Volt) does not discriminate against applicants based on citizenship status, immigration status, or national origin, in accordance with 8 U.S.C. § 1324b.
The company will consider for employment qualified applicants with arrest and conviction records in a manner that complies with the San Francisco Fair Chance Ordinance, the Los Angeles Fair Chance Initiative for Hiring Ordinance, and other applicable laws.
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