Job Description

Job Title: Clinical Quality Management Analyst – Contract – Must be US Citizen

Position Location: REMOTE but MUST RESIDE IN PA

This job works with appropriate departments in the areas of compliance, process improvement, medical record review and coding, and member and provider satisfaction for all product lines. Recommends and implements process improvements related to the potential of quality medical care and service to members and to improve documentation of these services for appropriate ICD 10-CM coding.

Responsibilities and Qualifications:

• This is a medical review position. Will be mining medical records

• Must be a Registered Nurse in PA

• Must have 3-5 years of medical review experience

• Must have HEDIS experience

• Must have medical review experience

• Must have Customer service experience

• Must have attention to detail

• Must be proficient in Excel

• Must be tech savvy

• Quality improvement experience preferred