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

Similar Jobs