Quality Review Specialist Jobs

ICD10 HCS-D certification strongly preferred.

Home Care Home Base software experience a plus!

Strong computer and technology skills required.

About Trinity Health At Home

Degree: Bachelor's preferred. Associate nursing degree considered if successfully demonstrated career progression and meets and exceeds performance expectations.

Ability to consistently demonstrate alignment to the Mission, Vision and Values, Organizational Code of Ethics and adhere to the Compliance Program.

Minimum of two (2) years care management experience required.

Possess strong critical thinking skills and knowledge of Medicare and Medicaid regulations.

Strong interpersonal and organizational skills.

Excellent written and verbal communication skill.

Excellent analytic skills, interpretation of data.

Working knowledge of audit techniques and methodologies.

Experience: Minimum of three years of clinical experience, two years in case, quality or utilization management.

9) Organizes and presents educational sessions related to projects and processes being managed.

10) Project manages disease management initiatives.

Participates in and successfully completes Mandatory Education.

Education: Graduate of a state approved and/or accredited School of Nursing

Licensure, Certification, Registration: Current license to practice professional nursing from the Massachusetts Board of Registration

Experience working with Medicaid or a Care Management Organization (CMO)

Maintain thorough knowledge of applicable federal and state programmatic and statutory requirements as they apply to regulatory reviews

Experience reviewing or auditing healthcare related records or reports.

Experience coordinating, implementing, and evaluating healthcare reporting processes.

Strong knowledge of healthcare terminology

Strong written and oral communication/presentation skills

Master’s degree in nursing, education or related field preferred.

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!

Affordable medical, dental and vision coverage for employee and family members

Knowledge of managed care processes.

Organizational skills and ability to meet deadlines and manage multiple priorities.

Proficient with Milliman Care Guidelines (MCG) management.

5 years combine knowledge of healthcare processes.

Verbal and written communication skills to include interfacing with staff across organizational lines plus interfacing with members and providers.

PC experience to include Microsoft Word, Access, and Excel.

Supports quality source selection and process reviews of suppliers' ability to meet program quality requirements.

1+ years of experience with NCM (Non-Conformance Issues)

1+ years of experience with Manufacturing Execution Systems common image (MESci)

Experience working in a cross functional environment

Collects and verifies data to support the identification of root cause routine problems.

Provides ideas and concepts for corrective action development.

Master’s degree in nursing, education or related field preferred.

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!

Affordable medical, dental and vision coverage for employee and family members

Minimum of two (2) years care management experience required.

Possess strong critical thinking skills and knowledge of Medicare and Medicaid regulations.

Strong interpersonal and organizational skills.

Excellent written and verbal communication skill.

Excellent analytic skills, interpretation of data.

Working knowledge of audit techniques and methodologies.

The responsibilities listed are a general overview of the position and additional duties may be assigned.

Performs quality review and edits of documents.

Assists in analyzing document content and designing intervention and training materials.

Identifies areas for improvement in production process.

Identifies trends/issues in preliminary data and report trends/issues.

Assists in the implementation of interventions.

1-2 years of experience in administrative or records management.

Are you an experienced Review Assistant looking for a new challenge?

Associate’s Degree and/or equivalent work experiences related to medical, behavioral, or social/support settings.

Knowledge of general review of records, claims or requests in a healthcare related field.

Knowledge the organization of medical records, medical terminology, disease process.

Working knowledge of software with healthcare or insurance application.

2+ years related experience required

Possess in-depth knowledge of recordkeeping and accounting system and have the ability to work with computer records

Strong understanding of custom and prototype plan provisions and apply this plan design knowledge to quality and reviews.

Good interpersonal, analytical, oral and written communication, organizational, problem solving and decision making skills

Skills That Will Help You Stand Out

Complete quality reviews on various roles within Client Onboarding and Deconversion Services (CODS)

Experience with time management and organizational skills

Experience applying applicable CT statutes, regulations, policies, procedures, standards, codes requirements and best practices

MINIMUM QUALIFICATIONS - GENERAL EXPERIENCE

MINIMUM QUALIFICATIONS - SPECIAL EXPERIENCE

Comprehensive Benefits including Industry leading health benefits, including medical and dental coverage.

Extensive pension plan and supplemental retirement offerings.

Review and summarize client responses for senior management to measure client sentiment

Identify and report time-sensitive inbound client emails to senior management to ensure they are addressed promptly

Bachelor's degree or equivalent combination of education and experience

Learn and stay up to date with national and international regulatory requirements

You will work with managers to recognize and mitigate risk

Get a 360-degree view and gain invaluable insight into various departments by helping you gain exposure and prepare for future roles

Comprehensive knowledge of closing policies and procedures, funding policies, underwriting requirements, governmental and agency requirements, terminology and automated processing systems

Six to eight years of relevant experience

Thorough knowledge of legal documents used to support applicable loan/lease processing

Comprehensive knowledge of applicable credit policies and approval processes for assigned product(s)

Excellent verbal and written communication skills

High school diploma or equivalent

Comprehensive knowledge of closing policies and procedures, funding policies, underwriting requirements, governmental and agency requirements, terminology and automated processing systems

Six to eight years of relevant experience

Thorough knowledge of legal documents used to support applicable loan/lease processing

Comprehensive knowledge of applicable credit policies and approval processes for assigned product(s)

Excellent verbal and written communication skills

High school diploma or equivalent

5 – 10 years of previous experience in long term care in a nursing management role.

Participates in the development of educational materials and staff training programs relative to long term care.

Participates in the compilation and completion of quarterly and other reports prepared for the HHC Board of Directors’ Planning Committee.

May attend HHC Planning Committee meetings as assigned to represent the Long Term Care Department or to present a special report.

Assists in the completion and follow up of any requests or directives resulting form the Planning Committee meetings as assigned.

Attends community and professional association functions and meetings representing HHC Long Term Care division as requested.