Job description
Company Background
Healthmap Solutions is the future of specialty health management that focuses on progressive diseases, with a particular expertise in kidney health populations. Healthmap Solutions uses clinical big data resources and high-powered analytics to power complex specialty health management programs. Healthmap Solutions is a diverse, growing company committed to our clients and our employees. We are champions for better health, for those who need us most.
Position Summary
The Clinical Quality Reviewer (CQR) position will work under the direction of a Clinical Quality Manager and will be responsible for completing quality reviews for Clinical Services and Provider Relations teams and report results individually and in the aggregate. This role will also support Quality Improvement Programs related to Delegation, Accreditation and Regulatory standards. This position will closely partner with Clinical Services, Provider Relations, and Clinical Training teams to improve the quality of the Kidney Health Management program and other clinical programs.
Responsibilities
As an Equal Opportunity Employer, we will not discriminate against any job candidate or employee due to age, race, religion, ethnicity, national origin, gender, gender identity/expression, sexual orientation, disability, familial status, veteran status, marital status, parental status, or pregnancy. In our innovative and inclusive workplace, we prohibit discrimination and harassment of any kind.
Healthmap Solutions is the future of specialty health management that focuses on progressive diseases, with a particular expertise in kidney health populations. Healthmap Solutions uses clinical big data resources and high-powered analytics to power complex specialty health management programs. Healthmap Solutions is a diverse, growing company committed to our clients and our employees. We are champions for better health, for those who need us most.
Position Summary
The Clinical Quality Reviewer (CQR) position will work under the direction of a Clinical Quality Manager and will be responsible for completing quality reviews for Clinical Services and Provider Relations teams and report results individually and in the aggregate. This role will also support Quality Improvement Programs related to Delegation, Accreditation and Regulatory standards. This position will closely partner with Clinical Services, Provider Relations, and Clinical Training teams to improve the quality of the Kidney Health Management program and other clinical programs.
Responsibilities
- Completes Quality Reviews and participates in Clinical Quality Improvement programs for the Clinical Operations departments.
- Ensures files reviewed are in alignment with Federal, state, local, CMS and accreditation standards.
- Participates in the generation and monitoring of clinical quality data required for internal, customer and NCQA reporting.
- Participates in and completes pre onsite reviews (client, regulatory or accreditation).
- Supports Clinical Operations in Pre-Delegation, Delegation and Accreditation reviews.
- Maintains a culture of collaboration, positivity, and motivation.
- Maintains all required quality, organization, and project documentation.
- Performs other related duties as assigned.
- A bachelor’s degree in a health-related field is desired. Applicable experience or licensure as a RN or LPN will be considered in lieu of a degree.
- 2+ years of care management or quality management experience is preferred.
- Experience working in electronic medical records is required.
- Knowledge of Regulatory, CMS and quality accreditation requirements is desired.
- Ability to generate reports and analyze data is required.
- Per Healthmap’s HR Security Policy, this position is considered HY (high risk for PHI and may require additional training/screening).
- Collaborative and solution oriented
- Proven quality experience as demonstrated through historical work/achievements
- Excellent verbal, written communication, and presentation skills
- Problem solving, analytical and strategic skills required
- Highly developed organizational skills; comfortable working under time sensitive deadlines
- Metrics driven
- Ability to manage multiple priorities
- Must be proficient in Microsoft Office:, Outlook, Word, Excel, PowerPoint
As an Equal Opportunity Employer, we will not discriminate against any job candidate or employee due to age, race, religion, ethnicity, national origin, gender, gender identity/expression, sexual orientation, disability, familial status, veteran status, marital status, parental status, or pregnancy. In our innovative and inclusive workplace, we prohibit discrimination and harassment of any kind.
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