Top 133 Record reviewer Jobs in New York, Ny

Clinical Quality Reviewer
US Family Health Plan @ SVCMC, Inc. —New York, NY
- $80,000 - $115,000 a year
- Full-time
- Nursing
- Anatomy knowledge
- Microsoft Outlook
- Commuter assistance
- Paid holidays
Quick Apply
Medical Records Reviewer
VNS Health —Manhattan, NY
- $28.09 - $35.08 an hour
- Full-time
- Nursing
- Microsoft Excel
- HIPAA
- Continuing education credits
- Paid holidays
QA Associate- Micro Reviewer
RK PHARMA INC —Pearl River, NY
- $55,000 - $95,000 a year
- Full-time
- Mid-level
- Bachelor's degree
- Communication skills
Quick Apply
Environmental Analyst 1 / Trainee 1 / 2 - NY HELPS
State of New York - Environmental Conservation, Department of —Long Island City, NY
- $53,764 - $85,138 a year
- Overtime
- Background check
- Word processing
- Master's degree
- Paid holidays
- Dental insurance
5d
Quality Control Reviewer II
1199SEIU Family of Funds —New York, NY
- $47,548.28 - $60,108.88 a year
- Full-time
- Microsoft Word
- Writing skills
- Mid-level
8d
Quality Control Reviewer III
1199SEIU Family of Funds —New York, NY
- $50,741.60 - $64,145.64 a year
- Full-time
- Microsoft Word
- Writing skills
- Mid-level
8d
Quality Monitoring Nurse Reviewer
ADMIN FOR CHILDREN'S SVCS —New York, NY
- $109,490 - $112,775 a year
- Full-time
- Nursing
- RN License
- Mid-level
- Loan forgiveness
10d
Medical Records Specialist
MedReview —New York, NY
- $47,000 a year
- Full-time
- Writing skills
- HIPAA
- English
Quick Apply
COMPLEX MEDICAL CASE REVIEWER
HRA/DEPT OF SOCIAL SERVICES —Manhattan, NY
- $118,749 a year
- Full-time
- Nursing
- Management
- Psychiatry
- Loan forgiveness
- Food provided
Training Facilitator
Research Foundation of The City University of New York —New York, NY
- $75,000 - $85,000 a year
- Full-time
- Hybrid work
- Mid-level
- Master's degree
- Presentation skills
Paralegal, Compliance & Investigations
WeWork —New York, NY
- $73,500 - $98,000 a year
- Full-time
- Hybrid work
- Spanish
- English
- Office
- Paid parental leave
- AD&D insurance
2d
MEDICAL REVIEWER
Zenith LifeScience —South Plainfield, NJ
- $100,000 - $120,000 a year
- Full-time
- Medicine
- Microsoft Excel
- English
Reviewer - Assistant Civil Engineer
DEPT OF ENVIRONMENT PROTECTION —New York, NY
- $66,330 - $76,279 a year
- Multiple hires
- Mid-level
- Office
- Master's degree
- Loan forgiveness
Reviewer- Assist. Civil Engineer
DEPT OF ENVIRONMENT PROTECTION —New York, NY
- $66,330 - $76,279 a year
- Multiple hires
- Civil engineering
- Writing skills
- Research
- Loan forgiveness
Supervising Performance Analyst
Graham Windham —Brooklyn, NY
- $71,190 - $73,190 a year
- Full-time
- Mid-level
- Office
- 3 years
- Health insurance
- 403(b)
Quick Apply
5d
Associate - Digital Product Management
American Express —New York, NY
- $78,000 - $124,750 a year
- Full-time
- Hybrid work
- Mid-level
- Product management
- US work authorization
- Paid parental leave
- Health insurance
Affordable Housing Compliance Expert | Housing
Elise A.I. Technologies Corp. —New York, NY
- $125,000 - $200,000 a year
- Full-time
- Mid-level
- Office
- Apartments
- Commuter assistance
- Paid parental leave
5d
Physician Reviewer - Physical Medicine and Rehabilitation (Utilization Review)
Dane Street, LLC —New York, NY
- Remote
- Physical & Rehabilitation Medicine
- Mid-level
Quick Apply
Training Expert
Kuehne+Nagel —Jersey City, NJ
- $80,000 - $95,000 a year
- Mid-level
- Continuous improvement
- US work authorization
- Health insurance
- 401(k)
Clinical Quality Assurance Specialist/ Clinical Supervisor (LCSW REQUIRED)
PARK SLOPE CENTER FOR MENTAL HEALTH, Inc —Brooklyn, NY
- $80,000 - $85,000 a year
- Full-time
- Hybrid work
- Management
- Licensed Clinical Social Worker
- Mid-level
- Paid holidays
- Health insurance
Quick Apply

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record reviewer jobs near new york, ny

Clinical Quality Reviewer

US Family Health Plan @ SVCMC, Inc. -
New York, NY

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Job Details

Full-time
$80,000 - $115,000 a year

Benefits

Commuter assistance
Paid holidays
Disability insurance
Health insurance
Dental insurance
401(k)
Employee assistance program
Vision insurance

Qualifications

Nursing
Quality control experience within healthcare industry
Quality of care (regulatory compliance area)
Nursing
Quality assurance experience within healthcare

Full Job Description

JOB SUMMARY

Reports to Team Lead, Clinical Quality and Record Review. Works independently and with other departments and/or vendors to ensure clinical potential quality issues are tracked, investigated and resolved in accordance with TRICARE and Plan requirements. Primarily responsible for conducting post-service in-depth clinical reviews (all care settings) in accordance with accepted standards of care. The overall goal is to improve clinical service delivery.

RESPONSIBILITIES

Clinical Review

Utilizes clinical expertise to conduct clinical case retrospective reviews to determine deviation from standard of care or gaps in care and presence of mandatory data elements. Document progress of investigation and findings in internal databases and/or Excel spreadsheets.
Conduct clinical literature reviews and summarize findings.
Contact providers/facilities, as applicable, to obtain information and/or medical records needed to conduct a comprehensive clinical review of cases and final determinations.
Conduct chart reviews and audits both electronic and at medical facilities and providers’ offices. Abstract data relevant to review target.
Write succinct and targeted investigative summaries. Write quality review determination letters.
Develop and manage collaborative relationships with internal/external stakeholders and vendor staff.
Maintain confidentiality of all medical records, correspondence and related documents.
Effectively meets strict deadlines.
Aware of the potential for fraud and waste and how to report suspected fraudulent activity.

Data Analysis and Reporting

Participate in collection and analysis of data for clinical CDRLs reports (i.e., monthly quality issue report, AHRQ PSI report, annual clinical quality management program report).
Participate in collection, analysis and presentation of data for Peer Review, Credentials Review and Quality Committees.
Evaluate data for trends.

Continuous Quality Improvement

Participate in continuous quality improvement activities/root cause analysis to resolve identified quality issues and ensure forward movement in beneficiary service delivery.
Cross-train and perform other duties as assigned or required within the Quality Department. Attends meetings to achieve departmental/organizational goals and objectives.

Experience

Five years of healthcare quality management experience.
Five years clinical nursing experience.
Quality assurance/improvement experience in a managed health plan, integrated health care system, or health care accreditation or regulatory agency.

Skills/Competencies

Ability to read, abstract and analyze medical records as well as other clinical data.
Analytical mindset with excellent organizational and problem-solving skills.
Ability to work both independently and as a team member.
Strong project management skills.
Intermediate statistical analysis expertise including interpretation of data.
Communications: Effective verbal and written communication skills. Able to work collaboratively with different teams and different team members. Ability to work both independently and as a team member.
Manages assigned caseload in accordance with established performance metrics.
Excellent customer service skills.
Understanding of medical terminology, anatomy, physiology and concepts of disease and health. Fundamental knowledge of ICD-10, CPT and HCPCS coding.
Understanding of Medicare, Medicaid and/or TRICARE.
Proficient in Microsoft Office, including but not limited to Excel, Outlook, PowerPoint and Word. Experience in Access and Visio a plus. Ability and inclination to adopt technology to maximize efficiency.
Decision making: Identification of clinical quality issues as evidenced by deviation from accepted standard of practice or gap in care. Ability to recommend corrective actions and/or sanctions.

Education/Certifications/License

Current and unrestricted state RN or LPN/LVN license required (CT, NJ, NY, PA)
BA, BS, or BSN preferred

SALARY RANGE: LPN/LVN $80,000 – $85,000.00 RN $107,000.00 - $115,000.00

Benefits Statement:

SVCMC, Inc. provides a robust benefits package that includes medical coverage through UnitedHealthcare/Oxford with no deductible for in-network services. Employees also receive vision coverage through UnitedHealthcare Vision and dental benefits through MetLife. Basic life and disability insurance are automatically provided at no cost. All employees are eligible for commuter benefits, tuition reimbursements, and a 401(k)-retirement plan with an immediate employer match that is fully vested from day one. SVCMC also offers a generous time off package, which includes vacation, 10 paid holidays, and 3 personal days. Additionally, employees have access to a comprehensive Employee Assistance Program and exclusive discounts through Working Advantage.

SVCMC IS AN EQUAL OPPORTUNITY EMPLOYER - ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO VETERAN STATUS, DISABILITY, OR OTHER CHARACTERISTICS PROTECTED BY LAW.

Mondays & Fridays Remote
Tuesday through Thursday In Office

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Refine Your Search

record reviewer jobs in new york, ny

Clinical Quality Reviewer

Medical Records Reviewer

QA Associate- Micro Reviewer

Environmental Analyst 1 / Trainee 1 / 2 - NY HELPS

Quality Control Reviewer II

Quality Control Reviewer III

Quality Monitoring Nurse Reviewer

Medical Records Specialist

COMPLEX MEDICAL CASE REVIEWER

Training Facilitator

Paralegal, Compliance & Investigations

MEDICAL REVIEWER

Reviewer - Assistant Civil Engineer

Reviewer- Assist. Civil Engineer

Supervising Performance Analyst

Associate - Digital Product Management

Affordable Housing Compliance Expert | Housing

Physician Reviewer - Physical Medicine and Rehabilitation (Utilization Review)

Training Expert

Clinical Quality Assurance Specialist/ Clinical Supervisor (LCSW REQUIRED)

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