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Clinical Reviewer

Company: Centene Coproration
Location: New York
Posted on: November 11, 2019

Job Description:

Description: Position Purpose: The Clinical Reviewer performs medical record reviews to determine the quality of care; identifies quality issues and assures compliance with medical record standards and regulatory mandates; works collaboratively with Fidelis Care New York providers and educates them on all aspects of medical record review criteria including QARR/HEDIS; conducts member and/or provider telephonic outreach when needed. Stays abreast to changes in Fidelis' Performance Management measures and systems and changes in clinical guidelines. Perform reviews of medical records and standards; post completed review reports with the number of records reviewed and quality issues noted. Collaborate with providers and adhere to clinical standards of care to ensure appropriate outcomes; practice and adhere to departmental, state and national guidelines. Educate providers on clinical guidelines and QARR/HEDIS measures. Communicate in an efficient, effective, and friendly manner with providers, internal, and external staff. Attend educational workshops; review professional publications; establish personal networks; participate in professional societies to maintain professional and technical knowledge. Travel when required.

Keywords: Centene Coproration, New York , Clinical Reviewer, Healthcare , New York, New York

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