Quality Review Auditor
About The Position
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. The MJHS Difference At MJHS, we are more than a workplace; we are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services. We foster collaboration, celebrate achievements, and promote fairness for all. Our contributions are recognized with comprehensive compensation and benefits, career development, and the opportunity for a healthy work-life balance, advancement within our organization and the fulfillment of having a lasting impact on the communities we serve.
Requirements
- Graduate from an accredited School of Nursing. BSN or BS degree preferred
- Minimum of two (2) years of working in care management experience required
- Licensed to practice as Registered Professional Nurse in NYS
- Excellent analytical skills, interpretation of data
- Strong critical thinking skills
- Knowledge of Medicare and Medicaid regulations
- Ability to set priorities and to handle multiple assignments
- Working knowledge of audit techniques and methodologies
- Working knowledge of State and Federal regulations
- Travels to perform business partners training
Nice To Haves
- Managed Care experience preferred
- BSN or BS degree preferred
Responsibilities
- Quality Review Auditor (QRA) is responsible for ongoing audits of the care management staff, quality assurance, accuracy and overall integrity of the care management records and documentation.
- QRA will listen to the calls completed by the care management staff to identify gaps in knowledge and assess for professionalism of the staff completing the calls.
- This role is to ensure compliance with NYS DOH and CMS regulations through development of audit tools and validating all data collected.
- Quality Review Auditor will be responsible to analyze collected audit data, identify trends for staff re-training and implementing corrective action plans in collaboration with Coordinated Care Management staff.
- Provide support to Directors, Managers and Supervisors to ensure that all documentation and reporting requirements are prepared and maintained in a professional and well-coordinated manner.
Benefits
- 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!
- Generous paid time off, including your birthday!
- Affordable and comprehensive medical, dental and vision coverage for employee and family members
- Two retirement plans! 403(b) AND Employer Paid Pension
- Flexible spending
- MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
