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Quality Review Auditor MJHS Job Description Job DescriptionThe 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.
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.
Graduate from an accredited School of Nursing. BSN or BS degree preferred Minimum of two (2) years of working in care management experience required Managed Care experience preferred 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 New York, NY, USPosted 13 hours ago Sr Financial Analyst. Reed Exhibitions Staff Services Specialist (Stamford, CT) sought by Coffee Shop & Specialty Bakery with exp. in the following: i) planning, executing, or assessing customer service initiatives and performance measurement criteria to enhance operations, (ii) analyzing data and statistics for trends based on recruitment practices, motivation, turnover, or compliance with employment laws, and iii) fostering positive relationships and communication with personnel to enhance workplace dynamics and productivity. No travel or lang. fluency req. Bachelor's degree in any field of study (or foreign equiv.) + 6M exp. in the job duties. Please send resumes by postal mail only to: Leyla Dam, Owner, LDam INC. DBA. Lorca, 125 Bedford Street, Stamford, CT 06901. Bridgeport, CT, US, 06604Posted 17 hours ago Full Time - Sales Specialist - ProServices - Day. Lowe's At Lowe’s, we’ve always been more than just an improvement store. We’re also home to everything that makes your home feel like home. And for thousands of Lowe’s associates, we’re home to fresh starts, rewarding opportunities, and endless career possibilities. Macedon, NY, US, 14502Posted 18 hours ago 2024 Investment Management Fall Co-Op Program - Product Development (New York) Morgan Stanley The MSIM Alternatives Product Development team is responsible for overseeing all aspects of fund launches for private equity, private credit, real estate, infrastructure and hedge funds. The team partners with portfolio manager during the creation, design, and execution phases of these fund launches. The team leads initiatives with the sales and distribution team on competitor analysis The team also equips the Sales and Distribution Teams with current market updates, competitor analysis and trends in efforts to develop and maintain the product development pipeline. New York, NY, US, 10261Posted 19 hours ago Billing Representative. Hackensack Meridian Health The Billing Representative is responsible for maintaining patient EMR, including processing physician orders and discharge summaries. In addition, responsible for processing billing information, including verifying accuracy and data entry into the system. Wall, NJ, USPosted 21 hours ago Assistant Financial Center Manager. Univest Financial Corporation Responsible for assisting the Financial Center Manager in all aspects of leading the sales and service function, management and audit & control for a designated Financial Center. This position will provide customers with quality sales and service, and has knowledge of and the ability to perform essential duties assigned to the FC staff along with directly supervising assigned employees. The incumbent will also oversee and ensure that the teller line operates in compliance with the bank's operational policies and procedures related to the processing of deposits, withdrawals, check cashing, cash handling, and other transactional and security operations. The incumbent in this position should typically have three or more years of experience in consumer banking. This position operates under the direct supervision of the Financial Service Center Manager. Bethlehem, PA, US, 18020Posted 21 hours ago Part Time Associate Banker Bilingual Mandarin and English Required (30 hours)Brooklyn West. JPMorgan Chase & Co We have an obsession for taking care of our customers and employees and making them feel welcomed and valued through building lasting relationships, doing the right thing, exceeding expectations, and having a strong commitment to diversity and inclusion. Using the latest banking solutions combined with cutting-edge financial technology and the most welcoming and friendly service, you will be front and center representing our brand and culture. You will have the opportunity to help people experience our Customer Promise - helping people make the most of their money so they can make the most of their lives, by providing education, and advice tailored to suit their financial needs. New York, NY, US, 11219Posted a day ago Coordinator - Financial . Columbia University The Financial Coordinator is responsible to process invoices for purchasing orders, check requests, Net30 invoices, and other types of financial transactions; performs billing and processes ITF; interacts with vendors and the administrative offices at Columbia, including Purchasing, Capital Assets Accounting, Accounts Payable, Sponsored Projects Administration, and Sponsored Projects Finance to assure a smooth flow of transactions, and resolves any processing issues with vendors and Columbia central offices in a timely manner. New York, NY, US, 10261Posted a day ago Accounts Payable / Receivable Specialist.Vaco By submitting to this position, you agree that you will be giving Vaco the exclusive right to present your as a candidate for the foregoing employment opportunity. You further agree that you have represented information about yourself accurately and have not affirmatively misrepresented your qualifications. You also agree to maintain as confidential, to the fullest extent permitted by law, any information you learn from Vaco about the position and you will limit disclosure of information about the position only to the extent necessary to perform any obligations in furtherance of your application. In exchange, Vaco agrees to exercise reasonable efforts to represent you through all solicitation, job screening and resume dispersal. Stamford, CT, US, 06925Posted a day ago MSK Finance May Hiring Event: Manager, Accounting - Grants. Memorial Sloan Kettering Cancer Center The people of Memorial Sloan Kettering Cancer Center (MSK) are united by a singular mission: ending cancer for life. Our specialized care teams provide personalized, compassionate, expert care to patients of all ages. Informed by basic research done at our Sloan Kettering Institute, scientists across MSK collaborate to conduct innovative translational and clinical research that is driving a revolution in our understanding of cancer as a disease and improving the ability to prevent, diagnose, and treat it. MSK is dedicated to training the next generation of scientists and clinicians, who go on to pursueour missionat MSK and around the globe. New York, NY, US, 10261Posted a day ago Description
Job Description Job Description
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.
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.
Graduate from an accredited School of Nursing. BSN or BS degree preferred Minimum of two (2) years of working in care management experience required Managed Care experience preferred 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 View more..