- Centene Corporation (New York, NY)
- …and requires an clinical license. 3+ years of nursing or quality improvement experience. **Licenses/Certifications:** Current state's clinical license ... processes to measure member outcomes. Assess provider performance and quality of care through clinical case reviews....and delivered timely + Perform other performance and process improvement activities + Performs other duties as assigned +… more
- ICON Clinical Research (Whitesboro, NY)
- Quality Assurance Auditor I - Whitesboro, NY USA (Onsite Hybrid) ICON plc is a world-leading healthcare intelligence and clinical research organization. ... us on our mission to shape the future of clinical development. We have an incredible opportunity for a ** Quality Assurance Auditor I** to join ICON's Full… more
- Humana (Albany, NY)
- …is a full-time, remote/work-from-home position. **Description** The Inpatient Medical Coding Auditor extracts clinical information from medical records and ... is looking is an experienced and well-grounded medical coding auditor to quality review the inpatient hospital...focus on DRG audits. You will also drive process improvement initiatives and develop educational materials. This is a… more
- Planned Parenthood of Central and Western NY (Rochester, NY)
- Billing Auditor for Shared Services Fully Remote * Rochester, Buffalo, or Syracuse, NY * Revenue Cycle Description Billing Auditor for Shared ServicesBuffalo, ... of PPCWNY's mission and the collaboration with Shared Services, the Billing Auditor evaluates Revenue Cycle outcomes to identify and recommend opportunities for … more
- Lotte Biologics USA LLC (Syracuse, NY)
- …ICH, ISO, PIC/S and other health authority guidelines. + American Society for Quality (ASQ) Certified Quality Auditor or equivalent preferred, willingness ... innovation, to reliably deliver benefits for patients worldwide. Position Summary The External Auditor , Supplier Quality and Quality Systems, is responsible… more
- Healthfirst (NY)
- …and/or at departmental team meetings + Assists with evaluating and analyzing aggregate quality performance data + Apply clinical and critical thinking skills to ... **Duties and Responsibilities:** + Conduct quality audits of A&G items cases grievances, pre-service...and fully resolved in a compliant manner. + Review clinical documentation for accuracy, completeness identifying any discrepancies or… more
- Catholic Health (Kenmore, NY)
- …consistent, accurate, and meets data integrity for use in billing, reimbursement, clinical outcomes, and for SPARCS reporting. The Educator/ Auditor will monitor ... Demonstrated ability to work closely with CH associates, medical staff, Clinical Documentation Improvement (CDI) leadership and staff, department managers,… more
- Trinity Health (Syracuse, NY)
- …authorization of medical services and procedures. Collaborates on system-wide quality improvement /performance improvement .Initiates and ensures ... utilization of health care services with the goal of maintaining high- quality cost-effective care. Works collaboratively with staff to obtain information from… more
- Cognizant (Albany, NY)
- …completeness, and compliance with regulatory and organizational standards. - **Enhance Clinical Documentation Quality ** . Collaborate with physicians through a ... an impact by playing a critical role in ensuring the accuracy, compliance, and quality of ICD-10-CM and ICD-10-PCS coding for inpatient records. You will be a valued… more
- Molina Healthcare (Syracuse, NY)
- **JOB DESCRIPTION** **Job Summary** Molina's Quality Improvement function oversees, plans, and implements new and existing healthcare quality improvement ... is responsible for developing, implementing, and monitoring the success of quality improvement interventions. The Manager works to coordinate resources… more
- Mount Sinai Health System (New York, NY)
- …MSHP seeks a Risk Adjustment Analyst support efforts to improve the overall quality and completeness of clinical documentation in outpatient physician practices. ... 2 years of HCC Risk Adjustment experience, preferred ? Clinical background in a healthcare setting, preferred ? Demonstrated...plan, monitor conditions prior to patient visits. * Facilitates improvement in the overall risk adjustment quality ,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …II (in addition to Level I Essential Accountabilities) + Handles all member clinical condition management programs. + Offers process improvement suggestions and ... Services (CMS), Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation standards, as appropriate to the member's case… more
- Wolters Kluwer (New York, NY)
- …consistent practices across the company. You will report to the VP, Clinical Content Management **RESPONSIBILITIES** ** Quality Management and Compliance** + ... approved locations on the posting). **OVERVIEW** You will be the global product quality lead in support of a broad portfolio of on-market medical devices including… more