Quality Review Supervisor Jobs

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?:

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

Responsibilities:

The Quality Review Supervisor, Care Management, is responsible for quality assurance, accuracy and overall integrity of the care management records completed by the Care Management staff. This role is to ensure compliance with NYS DOH and CMS regulations through development of auditing tools and data validation. The Quality Review Supervisor, Care Management, is responsible for analyzing collected audit data, identifying trends for staff re-training and implementing corrective action plans in collaboration with Clinical management and Staff Education. This Supervisor is responsible for overseeing the Fair Hearing process; coordinating and handling timely follow-up for Department of Health complaints; and providing support to the Director and Managers of the Coordinated Care Department to insure that all reporting requirements are prepared, submitted and maintained in a professional and well-coordinated manner.

Qualifications:

• Master’s degree in nursing, education or related field preferred.
• Baccalaureate Nursing Degree from an NLN-Accredited School of Nursing.
• Experience and knowledge of Managed Care: A minimum of two years nursing experience in Community Health or related field and/or minimum of two years of progressive job related experience, including care management and coordination, education and supervision.
• Licensed with current Registration to practice as Registered Professional Nurse in NYS.