RN Quality Assurance (Healthcare)
RN Quality Assurance (Healthcare) Syracuse, NY
Job type -Temp to Hire:
pay range for this position is $25 - $41/hr.
Job Description :-
Serving in a clinical capacity, this individual will accurately and
efficiently conduct medical reviews, including but not limited to
HEDIS/Quality Assurance Reporting Requirements (QARR), DOH
requests, prenatal and postpartum reporting and ad hoc requests
from Medical Directors. The QA Nurse will also participate in the
Quality Management program by identifying improvement
opportunities, development of barrier analysis and assisting in
development of interventions to improve outcomes.
Conducts retrospective multiple medical record reviews to retrieve
data for internal and external quality measures for HEDIS and QARR
Abstracts data from medical records, uses portable scanner to
retrieve relevant components of medical record (20%)
Responsible for the integrity of the data that is collected.
Identify improvement opportunities, conduct barrier analysis review,
and develop interventions to address identified barriers (20%)
Conduct telephonic outreach to members needing services identified
Telephonic outreach to Educate Providers on measures Identified on
Complies with all guidelines established by the Centers for Medicare
and Medicaid (CMS) and guidelines set forth by other regulatory
agencies, where applicable, and defined in the Universal American
And all other duties assigned by the manager and/or supervisor
Professional verbal and written communication skills, with the ability
Organizational skills with the ability to handle multiple tasks and/or
Time management skills with the ability to prioritize and schedule
daily activities for the most efficient use of time
Problem solving skills with the ability to look for root causes and
Must have a track record of producing work that is highly accurate,
demonstrates attention to detail, and reflects well on the
Responsibilities:
reporting. (20%)
on the Quality Workplan (20%)
the Quality work plan (20%)
Corporate and department policies.
Required Skills:
to clearly articulate thoughts and ideas
projects at one time
implementable, workable solutions
organization
Required Experience:
Undergraduate degree or equivalent experience
2 or more years of managed care experience
Current, unrestricted RN license in NY
Knowledge of ICD coding helpful
Quality Management, Case Management or Utilization Management
Personal computer experience should include working with Microsoft
Word, Excel, PowerPoint and Outlook at the intermediate level at a
Universal American Corp. is an Equal Opportunity / Affirmative
experience preferred
minimum
RN Quality Assurance (Healthcare) Syracuse, NY
Action Employer and does not discriminate because of age, color,
disability, ethnicity, marital or family status, national origin, race,
religion, sex, sexual orientation, military veteran status, or any other
characteristic protected by law. We are committed to attracting,
retaining and maximizing the performance of a diverse and inclusive
workforce.
Work Environment / Physical Demands:
Work is performed in a professional office setting, business casual
dress environment. Working extended hours may be required as
The physical demands for this position include exerting up to 10
pounds of force occasionally, and/or a negligible amount of force
frequently to lift, carry, push, pull or otherwise move objects,
including the human body. This is considered sedentary work, which
involves sitting most of the time; walking and standing are required,
as well on occasion. Telephone work and/or computer work are
typically required. Reasonable accommodations may be made to
enable individuals with disabilities to perform the essential functions.
needed.
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Contact: 703-349-2332
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