Clinical Reviewer Job at Swoon, New York, NY

U3NaSGg0dkx2OGJpN2VXZDZFVWFvbXBmY0E9PQ==
  • 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

Magi K

Ukrainian - English Over the phone Interpreter Job at Magi K

&##127775; We are Hiring UkrainianEnglish Over-the-Phone Interpreters! &##127775;&##128170; Do you want to work for the U.S.? This opportunity is for you!&##128204; Freelance Contract &##127911; Your Role: As an Over-the-Phone Interpreter (OPI) , youll provide... 

Keyzar Jewelry

Social Media Content Creator & Community Manager Job at Keyzar Jewelry

 ...brand experience and thats where you come in. &##127919; Role Overview We are seeking a highly creative Social Media Content Creator & Community Manager to lead Keyzars social presence and community-building efforts. You will produce engaging short-form... 

IntelyCare

Caregiver Job at IntelyCare

 ...Mountain Glen Caregiver Opportunity Do you want to make a meaningful difference in the lives of others? Do you like working with interesting people? Are you interested...  ...with residents, family members, and staff Assist residents in life skills and other life-enriching... 

Shepley Bulfinch

Healthcare Project Architect/Project Manager (PA/PM) Job at Shepley Bulfinch

 ...Description Job Description Come build something with Shepley Bulfinch! Shepley Bulfinch is seeking a well-rounded Healthcare Project Architect/Project Manager (PA/PM) to join our Durham studio. They are creative and passionate about architecture, curious about solving... 

UPS

Night-Shift Operations Coordinator, Cold-Chain Logistics Job at UPS

 ...in customer service operations, preferably within the air freight or logistics industry. Strong attention to detail and proficiency in MS Office are essential. This full-time role offers a supportive work environment focused on quality and teamwork.#J-18808-Ljbffr UPS