Clinical Reviewer Job at Swoon, New York, NY

WGVFbUxqdjEvVWhVRDZpNDE2M21lNEFtK2c9PQ==
  • Swoon
  • New York, NY

Job Description

Job Description

Clinical Quality Reviewer

Location: New York, NY

Pay Rate: $70/hour

Duration: Seasonal, approximately 7 months (November through May)

Travel: May require travel within the five boroughs

Position Overview

We are seeking an experienced Clinical Quality Reviewer to support an annual Medical Record Review initiative. This role focuses on auditing medical charts for compliance with HEDIS, QARR, and Medicare Advantage Star measure specifications. The reviewer will play a key role in meeting state and federal reporting requirements, including submissions to the New York State Department of Health and CMS.

Key Responsibilities

  • Maintain working knowledge of medical record review processes and EMR systems
  • Stay current on HEDIS, QARR, and Medicare Advantage Star specifications
  • Distribute medical record requests and coordinate appointments with provider offices
  • Conduct clinical audits using EMRs, paper medical records, and on-site provider visits
  • Collect and validate documentation supporting measure compliance
  • Accurately enter audit findings into designated systems following documentation standards
  • Ensure data integrity to support quality reporting and continuity of care

Required Qualifications

  • Clinical background required: Health Educator, LPN, RN, LMSW, or LCSW
  • Minimum of 2 years of hands-on HEDIS medical record review experience
  • Experience reviewing HEDIS and QARR measures in a managed care or health plan setting
  • Proficiency with Microsoft Word, Excel, PowerPoint, and Access

Licensure and Certification

  • Active or eligible licensure consistent with clinical background
  • Minimum of 2 years HEDIS review experience required

Job Tags

Seasonal work,

Similar Jobs

Sitter.com

Sitter Wanted - Seeking Responsible Sitter In Miami, Fl - $20.00 Hourly To Babysit A 3 Month Old Girl For 3 Hours Tonight Job at Sitter.com

Hello! We are a family in Miami, Florida looking for an occasional sitter to help us care for our newborn. We understand how precious this time is for our little one, and we want to ensure they are in the best hands when we need support.We are offering $20 per hour for... 

F.N.B. Corporation

AML and Sanctions Compliance Program Manager - Pittsburgh, PA Job at F.N.B. Corporation

 ...Pittsburgh, Pennsylvania. 15219. Join our team. Make a difference - for us and for your future. Position Title: AML and Sanctions Compliance Program Manager Business Unit: Compliance Reports to: Managing Director of AML Risk Management Position... 

Staffmark Group

Warehouse Order Selector Job at Staffmark Group

 ...with this policy and to act in accordance with it. All decisions with respect to employment matters and other phases of employer-temporary employee relationships will be in keeping with this policy and in accordance with all applicable laws and regulations. To... 

Pine Street Inn

Housing Placement Case Manager (Housing Navigation) Job at Pine Street Inn

 ...,000.00 at 24 months LOCATION: 444 Harrison Ave/PSI Shelters & community-based work SUMMARY OF POSITION: The Housing Navigation Case Manager (HNCM) will work within a team of case managers to ensure that we develop and execute sustainable and expeditious... 

Lakeland Regional Health

Palliative Care Physician Job at Lakeland Regional Health

 ...multiple workplace awards from highly reputable names including Aetna, Forbes and the Florida Hospital Association. Our 900-bed main campus...  ...Bannasch Institute for Advanced Rehabilitation Medicine, and is home to one of the nations busiest single site Emergency Department....