Clinical Review Specialist (Per Diem)

Req #:

2619

Job ID:

14141

Job Location:

New York, NY

Zip Code:

10041

Category:

Managed Care Nursing

Agency:

Status:

Per Diem

Office:

Salary:

$55.00 per hour

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

Why work for MJHS?:

When you work with us you will receive comprehensive and affordable health and financial benefits, in addition to generous paid vacation, personal and holiday time that you won't find at our competitors. Do you receive a paid day off for your birthday now? No?  You will here!  You will also receive the training, tuition assistance and career development you desire to help you achieve your career goals.  You take care of our patients, residents and health plan members, and we will take care of the rest!

 

Benefits include:

• Sign-on Bonuses OR Student Loan Assistance for clinical staff
• FREE Online RN to BSN and MSN degree programs!
• Tuition Reimbursement for all full and part-time staff
• Dependent Tuition Reimbursement for clinical staff!
• Generous paid time off
• Affordable medical, dental and vision coverage for employee and family members
• Two retirement plans! 403(b) AND Employer Paid Pension
• Flexible spending
• And MORE!

MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)

Responsibilities:

Responsible for quality management clinical review activities including but not limited to medical record reviews for the annual HEDIS project and quality of care issues. Works collaboratively with Provider Relations, Business Development, and external vendors to ensure compliance with medical record and incentive requirements.

Qualifications:

• RN required. Bachelors degree in healthcare, business, finance, or other related analytical fields
• Minimum 3-5 years’ experience in the healthcare or managed care industry, or related field
• Experience and knowledge with HEDIS, CAHPS, CMS Star Ratings, and Accreditation process

• Experience with project management skills, planning, and budgeting

• Ability to work in a fast-paced and dynamic environment with minimal supervision and direction and to constantly redefine responsibilities to meet business needs

• Acts with a sense of urgency

• Computer literacy and experience with word processing, spreadsheets, database programs and good typing skills

• Knowledge, understanding, and accurate interpretation of product line related specifications, methodologies, and processes

• Excellent interpersonal skills to manage, motivate, and influence departmental staff in successfully accomplishing of their duties

• Ability to demonstrate effective critical thinking and problem solving skills

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