RN Quality Assurance (Healthcare)

RN Quality Assurance (Healthcare)

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 to clearly articulate thoughts and ideas Organizational skills with the ability to handle multiple tasks and/or projects at one time 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 reporting.

Required Skills: to clearly articulate thoughts and ideas 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 minimum

Universal American Corp. is an Equal Opportunity / Affirmative 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 is performed in a professional office setting, business casual dress environment. Working extended hours may be required as needed. 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.