Clinical Quality Management Analyst
Job Description:
• This job works with appropriate departments in the areas of compliance, process improvement, medical record review and coding, and member and provider satisfaction for all product lines.
• Recommends and implements process improvements related to the potential of quality medical care and service to members and to improve documentation of these services for appropriate ICD 10-CM coding.
Qualifications:
• This is a medical review position. Will be mining medical records
• Must be a Registered Nurse in PA
• Must have 3-5 years of medical review experience
• Must have HEDIS experience
• Must have medical review experience
• Must have Customer service experience
• Must have attention to detail
• Must be proficient in Excel
• Must be tech savvy
• Quality improvement experience preferred
• Must complete the Clinical Quality Management Analyst Assessment.
Job Type: Contract
Pay: From $30.00 per hour
Expected hours: 40 per week
Application Question(s):
• Do you have a laptop for a glider assessment?
• Will you be able to complete the assessment after the call?
Education:
• Bachelor's (Required)
Experience:
• Medical Review: 3 years (Required)
• HEDIS: 3 years (Required)
• Customer service: 3 years (Required)
License/Certification:
• RN License (Required)
Work Location: Remote
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