Quality Reviewer

Minnetonka, MN

Quality Reviewer

Humera is seeking a Quality Reviewer for our client, a large health insurance provider, located Minnetonka. The Quality Reviewer performs data collection, review of medical records, quality reviews and audits to assure quality within network. This is a long term contract opportunity.

Duties

Data Collection/Audits (30%)

  • Implements tools, resources and programs to meet regulatory, accreditation, quality needs and financial goals.
Program Evaluation and documentation (40%)
  • Performs primary data collections and audits (HEDIS/Star, Risk Adjustment, RADV and Quality audits).
  • Documents and collects in the assigned time
Evaluate the process of the audit and make recommendation in improvement efforts (20%)
  • Assists with training of audits/data collection process
  • Actively participates in the debriefing of each data collection or audit process for quality improvement in process
Actively participates in the debriefing of each data collection or audit process for quality improvement in process
  • Assists in the writing of articles for Connections
  • Assists with the development of education materials for Providers and internal customers
  • Educates providers to assist them with quality improvement initiatives through 1:1 meetings, dissemination of educational materials and being a resources to the clinics 10%

Requirements

  • Bachelor’s degree or equivalent
  • 5 years clinical experience, must be broad based
  • 3 years managed care experience including provider/clinic profiling experience
  • 4 years medical record abstraction experience, including abstraction of records to support CPT and ICD codes billed
  • Demonstrated experience analyzing data and processes and developing recommendations
Certifications/Licenses:
  • Valid RN license

Post Date: 11.29.2018

Salary: Contact for Rate

Shift: 1st

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If you would prefer to speak directly to a Humera Staffing Consultant, please call us at 612-977-1440 and reference OrderID 816260


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For more than 45 years you may have known us as Dolphin Staffing - a name synonymous with quality temporary, and direct hire employment in the Minnesota. Today we are Humera - a boutique staffing agency that specializes in the placement of the best and brightest administrative and professional talent for contract, contract to hire and direct hire opportunities. Although we have changed our name, we continue to provide flexible career opportunities across a broad range of industries and with companies large and small. We invite you to become part of our elite workforce today!

Humera Administrative and Professional Staffing is an Equal Opportunity Employer.