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Job Description: Director of Coding Director of Coding Location: Hartford County, CT Salary:  Experience: 5.0 year(s) Job Type: Temporary to Full-Time Job ID: U994100       About the Opportunity A leading healthcare organization in the Greater Hartford area is looking for a Director of Coding to join their growing team.  This is a newly-created position due to the substantial growth this organization has seen. This organization, with over a decade of experience, is one of the leading providers of medical management services throughout Connecticut and is looking to add an experienced  manager to complement their talented team. Company Description Healthcare Organization Job Description The Director of Coding will: Provide direction, mentoring and support of the Professional Coder's daily functions Coordinate efforts with the Operations Leaders of each business/site Maintain expertise through hands on practice of all coding services provided to customers Conduct necessary research to address complex coding related challenges Assist in the education of providers and staff on proper documentation practices Develop, implement and maintain coding policies and procedures Assist in the facilitation of the transition from ICD-9 to ICD-10 and the training of internal staff Support coding staff in the resolution of vendor coding escalations Lead team meetings to enhance functional excellence  Required Skills Current Certified Professional Coding Certificate College Degree 5 years' experience of high-volume, multi-specialty coding within a Physician Office and/or Outpatient Clinic, 3 years in a management capacity Thorough knowledge of ICD-9-CM, CPT, and HCPCS coding Academic knowledge of ICD-10 PCS coding Functional knowledge of medical terminology, anatomy and physiology, medical procedures, medical conditions and illnesses, and treatment practices Knowledge of Medicare and other insurance carrier's coding and compliance guidelines Proficient in PC and MS Office skills

Job Description: Risk Adjustment Coding Nurse (RN) Risk Adjustment Coding Nurse (RN) Location: Nassau County, NY Salary:  Experience: 0.0 year(s) Job Type: Temporary / Consulting Job ID: U1008730       About the Opportunity A premier health insurance company located in Nassau County, NY is actively seeking a diligent and driven Registered Nurse (RN) for a promising opportunity on their staff in a Risk Adjustment Coding role. As a Risk Adjustment Coding Nurse, the qualified candidate conducts claims audits/reviews, identifies opportunities for improving individual member risk score accuracy and ensures risk adjustment clinical reviews are accurate, complete, specific and appropriate. Company Description Health Insurance Company Job Description The Risk Adjustment Coding Nurse (RN) will: Support all strategic tasks associated with the Risk Adjustment process Communicate with physicians and office staff on records needed for chart reviews Educate practitioners / clinical staff and provide ongoing clinical guidance related to the Risk Adjustment process Serve as a Subject Matter Expert and resource in Clinical Documentation Perform chart reviews for appropriateness and completeness of diagnostic codes based on CMS HCC categories Perform quality check on charts coded by vendor Collaborate in the development of coding or risk adjustment tools/training aides for contracted providers and staff Required Skills Comprehensive understanding of HCC coding rules, regulations and methodology Active Registered Nurse license Strong attention to detail Ability to multitask CCS or CPC  Coding Certification through AHIMA/AAPC

Job Description: In-Field Navigator In-Field Navigator Location: New York, NY Salary:  Experience: 2. year(s) Job Type: Full-Time Job ID: J137406       About the Opportunity A New York City-based healthcare organization is currently looking to add a licensed medical professional to their staff as their new In-Field Navigator. In this role, the In-Field Navigator will be responsible for providing educational support and training to Physicians, staff and Pharmacists at their practice locations and in the community to ensure compliance with a focus on HEDIS, QARR and Medicare Advantage Star measures and quality improvement activities. Apply today! Company Description Healthcare Organization Job Description The In-Field Navigator will be responsible for: Participating in initiatives across a broad array of clinical measures and health improvement activities Completing member outreach and education, as needed, to ensure members receive appropriate services Providing support and training to physicians on proper coding and medical record documentation practices to support improvement in quality metrics Facilitating referrals to Case Management to assist with the Transition of Care issues and customer service to address member concerns Required Skills 2+ years of related work experience Bachelor's Degree in a related field NYS Health Educator, Registered Nurse (RN), Licensed Practical Nurse (LPN), Licensed Master Social Worker (LMSW), Licensed Clinical Social Worker (LCSW), and/or Foreign Medical Graduate (FMG) Experience with Medical Record review working on HEDIS / QARR in a Healthcare and/or Managed Care setting Computer savvy Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Desired Skills Prior Quality Improvement experience in a Healthcare and/or Managed Care setting

Job Description: Clinical Quality Lead Clinical Quality Lead Location: New York, NY Salary:  Experience: 3. year(s) Job Type: Full-Time Job ID: J137405       About the Opportunity A healthcare organization in New York City is actively seeking a licensed medical professional to join their growing staff as a new Clinical Quality Lead. In this role, the Clinical Quality Lead is to provide direct supervision and support to a Quality Review team by assisting with on and off-site chart review, provider audits, member and provider education, and other duties as needed. Apply today! Company Description Healthcare Organization Job Description The Clinical Quality Lead will be responsible for: Assignment, coordination and tracking of tasks to all staff and preparation of weekly status and progress reports to the Director Development, implementation and updating of processes and tools that support quality review operations (i.e. audit tools, member and provider educational documents, provider educational tools, training manuals and tip sheets) Assisting in the development and implementation of initiatives across a broad array of clinical measures and health improvement activities Participation in the annual HEDIS and QARR hybrid medical record review project Participating in member outreach and education, as needed, to ensure members receive appropriate services Required Skills 3+ years of Quality Improvement experience Associate's Degree in Nursing NYS Health Educator, Registered Nurse (RN), Licensed Practical Nurse (LPN), Licensed Master Social Worker (LMSW), Licensed Clinical Social Worker (LCSW), and/or Foreign Medical Graduate (FMG) Experience with Medical Record review working on HEDIS / QARR in a Managed Care setting Previous experience with Coding and Chart Review Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Desired Skills Previous experience in a Healthcare and/or Managed Care setting Supervisory background

Job Description: OASIS Nurse Coordinator (RN) OASIS Nurse Coordinator (RN) Location: Nassau County, NY Salary: $78,000-$103,000 Experience: 2.0 year(s) Job Type: Full-Time Job ID: J135306       About the Opportunity A recognized hospital in Nassau County, NY is actively seeking a self-motivated and compassionate Registered Nurse (RN) for a promising opportunity on their staff as an OASIS Coordinator. In this role, the OASIS Nurse Coordinator will be responsible for analyzing data integrity and consistency of OASIS documentation and assessment processes. Company Description Hospital Job Description The OASIS Nurse Coordinator (RN): Ensures appropriate ICD-10 Coding and sequencing Educates/works with clinical staff to clarify documentation and data integrity issues Performs other tasks as necessary Required Skills Active New York State Registered Nurse license BSN Home Care Coding Specialist (HCS-D Certified) 2 years home care experience in CHHA OASIS Specialist certification COS-C certified 1-2 years of Home Health Care experience Desired Skills 1-2 years of OASIS review/coding experience in a Home Health Agency

Job Description: Quality Practice Advisor Quality Practice Advisor Location: Jacksonville, FL Salary: $60,000-$85,000 Experience: 2.0 year(s) Job Type: Full-Time Job ID: J137523       About the Opportunity An established managed care company in Jacksonville, FL is actively seeking a self-motivated and dynamic individual for a promising opportunity on their staff as a Quality Practice Advisor. In this role, the Quality Practice Advisor establishes and fosters a healthy working relationship between large physician practices, IPAs and the company. Apply today! Company Description Managed Care Company Job Description The Quality Practice Advisor: Advises and educates large Provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements Collects, summarizes and trends provider performance data to identify and strategize opportunities for provider improvement Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters) Delivers provider specific metrics and coach providers on gap closing opportunities Identifies specific practice needs where the company can provide support Develops, enhances and maintains provider clinical relationship across product lines Defines gaps in the company's service relationship with providers and facilitate resolution Leads and/or supports collaborative business partnerships Partners with physicians/physician staff to find ways to explore new ways to encourage member clinical participation in wellness and education Required Skills Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field One of the following: Certified Coding Specialist (CCS), LPN, LCSW, LMHC, LMSW, LMFT,  LVN, RN, NP, record review and/or Quality Improvement with experience in data and chart reviews to provide consultation and education to providers and provider staff 3+ years of directly related HEDIS record collection with analytical review/evaluation and / or Quality Improvement 1+ year of experience in Managed Care  3 + years of directly related HEDIS record collection with analytical review/evaluation and / or Quality Improvement 2+ years of experience in directly related HEDIS medical Knowledge of medical terminology and/or experience with CPT and ICD-9 coding Desired Skills Master's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field

Job Description: Assistant Vice President - Compliance Assistant Vice President - Compliance Location: Nassau County, NY Salary: $180,000-$210,000 Experience: 7.0 year(s) Job Type: Full-Time Job ID: J131560       About the Opportunity A driven and diligent healthcare professional is actively being sought out by a hospital in Nassau County, NY for a promising opportunity on their staff as their Assistant Vice President of Compliance. Reporting to the Senior Vice President of Internal Audit and Compliance, the Assistant Vice President of Compliance will assist in executing and monitoring compliance initiatives within the hospital and its affiliates. Company Description Hospital Job Description The Assistant Vice President of Compliance will: Maintain abreast of compliance issues and regulations related to the healthcare industry, annual coding updates and frequent regulatory changes Exercise due professional care in performing compliance reviews Understand and maintain strict confidentiality of patient information, work plans and projects Coordinate internal and external efforts to ensure adequate compliance audit coverage and to minimize duplicate efforts Manage assigned staff Perform routine compliance monitoring as deemed necessary Manage/oversee the management of the physician audit program Maintain and distribute relevant compliance educational materials and regulatory compliance updates Perform research on compliance issues as they arise from internal and external inquiries and document research, Serve as a resource for department managers, staff, physicians and administration Perform other tasks as necessary Required Skills Bachelor's Degree CPC, CCS, CCS-P and/or RHIA 7-10 years of experience in the healthcare industry, of which 2-3 years were spent in a position with supervisory or managerial responsibilities 5+ years of hospital and physician coding experience Proficiency in applying compliance standards, procedures and techniques is required in performing compliance reviews Understanding of management principles Knowledge of the fundamentals of such subjects as accounting, economics, commercial law, finance, qualitative methods and computerized systems Extensive knowledge of ICD-9, ICD-10 and CPT coding principles, guidelines and practices Strong analytical and problem-solving skills Strong computer skills, particularly Word and Excel Expertise in report writing and oral presentations Strong professional attitude Ability to work with and communicate effectively with all levels of management  Desired Skills MBA or MA in hospital administration

Job Description: HEDIS Coordinator HEDIS Coordinator Location: Miami, FL Salary:  Experience: 0.0 year(s) Job Type: Temporary / Consulting Job ID: U1008088       About the Opportunity A premier healthcare organization headquartered in Miami is actively seeking a driven and diligent professional for a rewarding opportunity on their staff as their HEDIS Coordinator. In this role, the HEDIS Coordinator will be responsible for coordinating and completing HEDIS Quality Department specific projects ensuring consistency with company strategy, commitments, and goals. Additionally, the HEDIS Coordinator serves as a consultant, educator, and policy changer in the use of HEDIS data and the quality improvement process. Company Description Healthcare Organization Job Description The HEDIS Coordinator: Coordinates annual HEDIS medical record collection and/or abstraction process Analyzes plan/market results Assists in the development of training materials, templates, processes, and procedures related to the project Serves as resource and liaison for multiple associates to complete assignments Collaborates with teams regarding work flow process improvement, document management, and abstraction education Researches patient treatment, diagnosis, and related procedures using coded data to produce HEDIS results using organized charts or Electronic Medical Record (EMR) systems Required Skills High School Diploma Experience in all aspects of process development and execution Polished and professional demeanor Familiar with Electronic Medical Records Proficiency with computer platforms and applications Strong clinical skills and knowledge Detail-oriented Ability to multitask Excellent communication skills Highly organized Desired Skills 1+ year of experience with HEDIS activity coordination and working with Managed/Acute/Provider Care environment Associate's or Bachelor's Degree RN, RHIA or RHIT license NCQA and HEDIS experience

Job Description: HEDIS Coordinator HEDIS Coordinator Location: Tampa, FL Salary:  Experience: 0.0 year(s) Job Type: Temporary / Consulting Job ID: U1008089       About the Opportunity A premier healthcare organization headquartered in Tampa is actively seeking a driven and diligent professional for a rewarding opportunity on their staff as their HEDIS Coordinator. In this role, the HEDIS Coordinator will be responsible for coordinating and completing HEDIS Quality Department specific projects ensuring consistency with company strategy, commitments, and goals. Additionally, the HEDIS Coordinator serves as a consultant, educator, and policy changer in the use of HEDIS data and the quality improvement process. Company Description Healthcare Organization Job Description The HEDIS Coordinator: Coordinates annual HEDIS medical record collection and/or abstraction process Analyzes plan/market results Assists in the development of training materials, templates, processes, and procedures related to the project Serves as resource and liaison for multiple associates to complete assignments Collaborates with teams regarding work flow process improvement, document management, and abstraction education Researches patient treatment, diagnosis, and related procedures using coded data to produce HEDIS results using organized charts or Electronic Medical Record (EMR) systems Required Skills High School Diploma Experience in all aspects of process development and execution Polished and professional demeanor Familiar with Electronic Medical Records Proficiency with computer platforms and applications Strong clinical skills and knowledge Detail-oriented Ability to multitask Excellent communication skills Highly organized Desired Skills 1+ year of experience with HEDIS activity coordination and working with Managed/Acute/Provider Care environment Associate's or Bachelor's Degree RN, RHIA or RHIT license NCQA and HEDIS experience

Job Description: Quality Information Specialist Quality Information Specialist Location: Jacksonville, FL Salary:  Experience: 2.0 year(s) Job Type: Temporary / Consulting Job ID: U1014668       About the Opportunity An established managed care organization located in Jacksonville, FL is actively seeking a compassionate and driven healthcare professional for a promising opportunity on their staff as a Quality Information Specialist. In this role, the Quality Information Specialist establishes and fosters a healthy working relationship between large physician practices, IPAs and the organization. For the right candidate, this role has the potential to transition into a full-time opportunity. Apply today! Company Description Managed Care Organization Job Description The Quality Information Specialist (RN): Advises and educates large Provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements Collects, summarizes and trends provider performance data to identify and strategize opportunities for provider improvement Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters) Delivers provider specific metrics and coach providers on gap closing opportunities Identifies specific practice needs where the organization can provide support Develops, enhances and maintains provider clinical relationship across product lines Leads and/or supports collaborative business partnerships, elicit client understanding and insight to advise and make recommendations Partners with physicians/physician staff to find ways to explore new ways to encourage member clinical participation in wellness and education Provides resources and educational opportunities to provider and staff Captures concerns and issues in action plans as agreed upon by provider Required Skills Bachelor's Degree in Nursing or equivalent work experience of 3+ years directly related HEDIS record collection with analytical review/evaluation and / or Quality Improvement; or 2+ years of experience in directly related HEDIS medical record review and/or Quality Improvement with experience in data and chart reviews to provide consultation and education to providers and provider staff 1+ year of experience in Managed Care experience One of the following: LPN, RN, APRN Proficient in Microsoft Office programs Proficient in Generic Healthcare Management Systems Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions Demonstrated interpersonal/verbal communication skills Knowledge of medical terminology and/or experience with CPT and ICD-9 coding Ability to multitask Desired Skills Master's Degree in Nursing One fo the following: HCQM, CHP, CPHQ

Job Description: Quality Information Specialist Quality Information Specialist Location: Cocoa Beach, FL Salary:  Experience: 0.0 year(s) Job Type: Temporary / Consulting Job ID: U1015295       About the Opportunity An established managed care company located in Cocoa Beach, FL is actively seeking a diligent and patient-oriented Nurse to join their staff as a Quality Information Specialist. In this role, the Quality Information Specialist establishes and fosters a healthy working relationship between large physician practices, IPAs and the company. Apply today! Company Description Managed Care Company Job Description The Quality Information Specialist: Advises and educates large Provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements Collects, summarizes and trends provider performance data to identify and strategize opportunities for provider improvement Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters) Delivers provider specific metrics and coach providers on gap closing opportunities Develops, enhances and maintains provider clinical relationship across product lines Leads and/or supports collaborative business partnerships, elicit client understanding and insight to advise and make recommendations Partners with physicians/physician staff to find ways to explore new ways to encourage member clinical participation in wellness and education Captures concerns and issues in action plans as agreed upon by provider Documents action plans and details of visits and outcomes and reports critical incidents and information regarding quality of care issues Required Skills Bachelor's Degree in Nursing  or equivalent work experience of 3+ years directly related HEDIS record collection with analytical review/evaluation and/or Quality Improvement 2+ years of experience in directly related HEDIS medical record review and/or Quality Improvement with experience in data and chart reviews to provide consultation and education to providers and provider staff 1+ year of experience in Managed Care experience Active Registered or Practical Nurse license; or Acute Care Nurse Practitioner license Demonstrated interpersonal/verbal communication skills Knowledge of medical terminology and/or experience with CPT and ICD-9 coding Proficient in Microsoft Office Knowledge of healthcare delivery Understanding of data analysis and continuous quality improvement process Desired Skills Health Care Quality and Management Certified Healthcare Professional Certified Professional in Healthcare Quality

Job Description: Documentation Specialist Documentation Specialist Location: Staten Island, NY Salary: $75,000-$95,000 Experience: 2.0 year(s) Job Type: Full-Time Job ID: J137595       About the Opportunity A widely recognized healthcare facility located on Staten Island is actively seeking a self-motivated and compassionate healthcare professional for a promising opportunity on their staff as a Documentation Specialist. In this role, the Documentation Specialist will be responsible for ensuring that clinical documentation in the medical record is pertinent, timely, accurate and complete. This is a fantastic opportunity for a qualified individual to advance their career with a respected healthcare facility in New York. Apply today! Company Description Healthcare Facility Job Description The Documentation Specialist will: Concurrently interact with Physicians, nursing staff, members of the interdisciplinary team and HIM coders Ensure that documentation captures clinical severity to support the level of service, core measures and appropriate reimbursement Educate all members of the patient care team on an ongoing basis Perform other tasks as necessary Required Skills BSN 5+ years of recent clinical experience in an acute care setting Experience in a hospital setting Strong computer skills Ability to maintenance stats and outcome data Strong interpersonal skills Desired Skills MD or New York State Registered Nurse license Coding experience Proficient in Microsoft Access, Excel, and Word

Job Description: Quality Information Specialist Quality Information Specialist Location: Fort Myers, FL Salary:  Experience: 2.0 year(s) Job Type: Temporary / Consulting Job ID: U1014671       About the Opportunity An established managed care organization located in Fort Myers, FL is actively seeking a compassionate and driven healthcare professional for a promising opportunity on their staff as a Quality Information Specialist. In this role, the Quality Information Specialist establishes and fosters a healthy working relationship between large physician practices, IPAs and the organization. For the right candidate, this role has the potential to transition into a full-time opportunity. Apply today! Company Description Managed Care Organization Job Description The Quality Information Specialist (RN): Advises and educates large Provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements Collects, summarizes and trends provider performance data to identify and strategize opportunities for provider improvement Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters) Delivers provider specific metrics and coach providers on gap closing opportunities Identifies specific practice needs where the organization can provide support Develops, enhances and maintains provider clinical relationship across product lines Leads and/or supports collaborative business partnerships, elicit client understanding and insight to advise and make recommendations Partners with physicians/physician staff to find ways to explore new ways to encourage member clinical participation in wellness and education Provides resources and educational opportunities to provider and staff Captures concerns and issues in action plans as agreed upon by provider Required Skills Bachelor's Degree in Nursing or equivalent work experience of 3+ years directly related HEDIS record collection with analytical review/evaluation and / or Quality Improvement; or 2+ years of experience in directly related HEDIS medical record review and/or Quality Improvement with experience in data and chart reviews to provide consultation and education to providers and provider staff 1+ year of experience in Managed Care experience One of the following: LPN, RN, APRN Proficient in Microsoft Office programs Proficient in Generic Healthcare Management Systems Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions Demonstrated interpersonal/verbal communication skills Knowledge of medical terminology and/or experience with CPT and ICD-9 coding Ability to multitask Desired Skills Master's Degree in Nursing One fo the following: HCQM, CHP, CPHQ

Job Description: Quality Practice Advisor (RN) Quality Practice Advisor (RN) Location: Tampa, FL Salary:  Experience: 3.0 year(s) Job Type: Temporary / Consulting Job ID: U1011418       About the Opportunity A Florida-based healthcare company is currently seeking a licensed Registered Nurse (RN) to join their staff as a Quality Practice Advisor. In this role, the Quality Practice Advisor (RN) will be responsible for strategizing with providers at their medical offices to close care gaps and provide guidance on quality measures, educating providers, etc. Apply today! Company Description Healthcare Company Job Description The Quality Practice Advisor (RN) will be responsible for: Advising and educating large Provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements Collecting, summarizing and trending provider performance data to identify and strategize opportunities for provider improvement Identifying specific practice needs where the company can provide support Developing, enhancing and maintaining provider clinical relationship across product lines Leading and/or supporting collaborative business partnerships, elicit client understanding and insight to advise and make recommendations Partnering with Physicians / Physician staff to find ways to explore new ways to encourage member clinical participation in wellness and education Providing communication, such as: newsletter articles; member education; outreach interventions; and, provider education Supporting quality improvement HEDIS and program studies as needed; requesting records from providers; maintaining databases; and, researching to identify members' provider encounter history Required Skills 3+ years of directly related HEDIS record collection experience; 2+ years of experience in directly related HEDIS medical record review and/or Quality Improvement with experience; 1+ year of Managed Care experience Bachelor's Degree in Nursing FL Registered Nurse (RN), Licensed Practical Nurse (LPN), and/or Acute Care Nurse Practitioner (APRN) license Knowledge of Medical terminology and/or experience with CPT and ICD-9 coding (Intermediate) Microsoft Office/Suite proficient (Excel, PowerPoint, Outlook, Word, etc.) Knowledge of Healthcare delivery (Intermediate) Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Desired Skills Master's Degree in Nursing Active license in: Health Care Quality and Management (HCQM); Certified Healthcare Professional (CHP); and, Certified Professional in Healthcare Quality (CPHQ)

Job Description: Quality Practice Advisor Quality Practice Advisor Location: Trenton, NJ Salary:  Experience: 3. year(s) Job Type: Temporary / Consulting Job ID: U1011207       About the Opportunity A healthcare company in New Jersey is actively seeking a licensed / certified professional to join their growing staff as a Quality Practice Advisor. In this role, the Quality Practice Advisor will be responsible for educating providers and supports provider practice sites in regards to the National Committee for Quality Assurance (NCQA) HEDIS measures. Apply today! Company Description Healthcare Company Job Description The Quality Practice Advisor will be responsible for: Advising and educating large Provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements Collecting, summarizing and trending provider performance data to identify and strategize opportunities for provider improvement Delivering provider specific metrics and coach providers on gap closing opportunities Identifying specific practice needs where the company can provide support Developing, enhancing and maintaining provider clinical relationship across product lines Leading and/or supporting collaborative business partnerships, elicit client understanding and insight to advise and make recommendations Partnering with Physicians / Physician staff to find ways to explore new ways to encourage member clinical participation in wellness and education Providing resources and educational opportunities to provider and staff Documenting action plans and details of visits and outcomes and reporting critical incidents and information regarding quality of care issues Communicating with external data sources as needed to gather data necessary to measure identified outcomes Required Skills 3+ years of directly-related experience in HEDIS record collection with analytical review / evaluation and/or Quality Improvement; 1+ year of Managed Care experience Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field One of the following licenses: Certified Coding Specialist (CCS); Licensed Practical Nurse (LPN); Licensed Clinical Social Worker (LCSW); Licensed Mental Health Counselor (LMHC); Licensed Master Social Work (LMSW); Licensed Marital and Family Therapist (LMFT); Licensed Vocational Nurse (LVN); Licensed Registered Nurse (RN); and/or, Acute Care Nurse Practitioner (APRN) (ACNP-BC) Solid analytical skills Computer savvy Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Desired Skills Master's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field One of the following licenses: Health Care Quality and Management (HCQM); Certified Healthcare Professional (CHP); and, Certified Professional in Healthcare Quality (CPHQ)

Job Description: HEDIS Reviewer HEDIS Reviewer Location: Newark, NJ Salary: $20-$23 per hour Experience: 0.0 year(s) Job Type: Temporary / Consulting Job ID: U1013482       About the Opportunity An established managed care company located in Newark is actively seeking a self-motivated and dynamic individual for a promising opportunity on their staff as a HEDIS Reviewer. In this role, the HEDIS Reviewer collects data for ambulatory medical record reviews and compliance with provider preventive health and chronic disease outcome improvement interventions. Apply today! Company Description Managed Care Company Job Description The HEDIS Reviewer: Prepares reports and quality improvement studies in an accurate, concise and timely fashion Conducts internal auditing for compliance with regulatory and accreditation standards Communicates with external data sources as needed to gather data necessary to measure identified outcomes Provides communication such as newsletter articles, member education, outreach interventions and provider education Collects and summarizes performance data and identifies opportunities for provider improvement Participates in site visit preparation and execution by regulatory and accreditation agencies Pursues methods to ensure receipt of data required for trending and reporting of various QI work plan metrics Ensures that documentation produced and/or processed complies with state regulations and/or accrediting body requirements Ensures assigned contract/regulatory report content is accurate and that submission adheres to deadline Required Skills Bachelor's Degree in a related field or equivalent work experience 3+ years of experience in HEDIS and/or quality improvement Experience in a managed care health services environment Experience in data collection and data entry Knowledge of medical terminology and/or experience with CPT and ICD-9 coding Demonstrated interpersonal/verbal communication skills Proficient in Microsoft Office programs, including Word, Excel, Access and PowerPoint Ability to work in a fast-paced environment with changing priorities

Job Description: Trauma Program Manager (RN) Trauma Program Manager (RN) Location: New York, NY Salary: $80,000-$130,000 Experience: 2.0 year(s) Job Type: Full-Time Job ID: J137050       About the Opportunity A medical center in New York City is currently seeking a licensed Registered Nurse (RN) for a promising Manager-level position with their growing Trauma Program. In this role, the Trauma Program Manager (RN) will be responsible for managing clinical services, systems, and performance improvement activities as they elate to a multidisciplinary approach to providing care to injured patients. Apply today! Company Description Medical Center Job Description The Trauma Program Manager (RN) will: Collaborate with the Nurse Executive to establish nursing care standards and evaluates staff compliance Develop unit goals and objectives to support the institutional values and goals with input from staff Provide intramural and extramural education for professional staff as related to the care of trauma patients Monitor indicators of clinical process indicators, system issues, and outcomes related to the quality of care provided to trauma patients Manage the operational, personnel, and financial aspects of the trauma program, as needed Serve as a liaison to hospital administration for the Trauma Program Oversee the collection, coding, storage, use, and validation of data on trauma patient while protecting patient confidentiality Serve as internal resource for staff throughout the hospital and an external resource for pre-hospital providers for issues related to the care of trauma patients Assist in facilitating research and protocol design, data collection, analysis, and publication efforts Participate in the development of trauma care systems at the community, state, and national levels Required Skills 2+ years of previous experience as a Trauma Manager Bachelor's Degree in Nursing NYS Registered Nurse (RN) license Previous experience in an Emergency Room setting Solid assessment, clinical, and documentation skills Patient oriented Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Able to multitask efficiently and effectively

Job Description: Assistant Director of Bill Review and Audit (RN) Assistant Director of Bill Review and Audit (RN) Location: Bedminster, NJ Salary: $95,000-$105,000 Experience: 5.0 year(s) Job Type: Full-Time Job ID: J135403       About the Opportunity A healthcare organization in New Jersey is currently seeking a licensed Registered Nurse (RN) to join their Management Team as their new Assistant Director of Bill Review and Audit. In this role, the Assistant Director of Bill Review and Audit (RN) will be responsible for evaluating the current non-accept process and processing all "non-accepts" on a daily basis that have been submitted by Nurse Auditor staff. Apply today! Company Description Healthcare Organization Job Description The Assistant Director of Bill Review and Audit will be responsible for: High dollar claim distribution Overseeing Peer Review activity Serving as a clinical resource for bill review appeals Serving as a liaison for the Pharmacist Consultant & Medical Recovery Services Identifying new vendor relationships and revenue opportunities Establishing goals and objectives and recommending new methods to improve departmental procedures Identifying new tools and software's via third party vendors to be used to enhance the audit process Identifying seminars, boot camps, and training opportunities to continue education of Nurse Audit staff Conducting weekly/bi-weekly departmental meetings and case studies Assisting in recruiting Nurse Auditors with the assistance of the Human Resource Department Required Skills 7+ years of Auditing, Claims, Review, and/or Billing experience with a Healthcare Organization; 4+ years of previous Management experience Bachelor's Degree in a related field NJ Registered Nurse (RN) license Experience and working knowledge of Healthcare, Medicare guidelines and various Healthcare programs Exceptional clinical skills to evaluate appropriate Medical Record Coding Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized

Job Description: Quality Practice Advisor Quality Practice Advisor Location: Jacksonville, FL Salary:  Experience: 2.0 year(s) Job Type: Temporary / Consulting Job ID: U1011417       About the Opportunity A widely recognized managed care organization headquartered in Jacksonville, FL is actively seeking a self-motivated and compassionate healthcare professional fro a promising opportunity on their staff as a Quality Practice Advisor. In this role, the Quality Practice Advisor educates providers and supports provider practice sites in regards to the National Committee for Quality Assurance (NCQA) HEDIS measures. Company Description Managed Care Organization Job Description The Quality Practice Advisor (RN): Collects, summarizes and trends provider performance data to identify and strategize opportunities for provider improvement Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment and Operations Delivers provider specific metrics and coach providers on gap closing opportunities Identifies specific practice needs where the organization can provide support Develops, enhances and maintains provider clinical relationship across product lines Defines gaps in the organization's service relationship with providers and facilitate resolution Leads and/or supports collaborative business partnerships Partners with physicians/physician staff to find ways to explore new ways to encourage member clinical participation in wellness and education Provides resources and educational opportunities to provider and staff Captures concerns and issues in action plans as agreed upon by provider Required Skills Bachelor's Degree in Nursing or equivalent work experience of 3 + years directly related HEDIS record collection with analytical review/evaluation and / or Quality Improvement 2+ years of experience in directly related HEDIS medical record review and/or Quality Improvement with experience in data and chart reviews to provide consultation and education to providers and provider staff 1+ year of experience in Managed Care experience One of the following licenses:  Licensed Practical Nurse, Registered Nurse (RN), Acute Care Nurse Practitioner (APRN) Demonstrated interpersonal/verbal communication skills Knowledge of medical terminology and/or experience with CPT and ICD-9 coding Ability to implement process improvements Knowledge of healthcare delivery Proficient in Microsoft Office programs and Healthcare Management Systems Desired Skills Master's Degree in Nursing

Job Description: Patient Care Advocate Patient Care Advocate Location: Fort Myers, FL Salary:  Experience: 2. year(s) Job Type: Temporary / Consulting Job ID: U1013180       About the Opportunity A healthcare company in Florida is currently seeking a licensed medical professional to join their growing staff as a Patient Care Advocate. In this role, the Patient Care Advocate will be responsible for working with members and providers to close care gaps, ensuring barriers to care are removed, and improving the overall member and provider experience through outreach and face-to-face interaction with members and providers at large IPA and/or group practices. Apply today! Company Description Healthcare Company Job Description The Patient Care Advocate will: Act as a liaison and member advocate between the member/family, Physician and facilities/agencies Act as the face of the companyin the provider community with the providers' and offices staff where their services are embedded Advises and educate Provider practices in appropriate HEDIS measures, and HEDIS ICD-10 /CPT coding in accordance with NCQA requirements Assess provider performance data to identify and strategize opportunities for provider improvement Collaborate with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment, Operations (claims and encounters) Schedule doctor appointments for members with care gaps to access needed preventive care services and close gaps in care in the provider's office Conduct face-to-face education with the member and their family, in the provider's office, about care gaps identified, and barriers to care Conduct telephonic outreach and health coaching to members to support quality improvement, regulatory and contractual requirements Arrange transportation for members, as needed Arrange follow-up appointments for member, as needed Document all actions taken regarding contact related to member Interact with other departments including customer service to resolve member issues Refer to case or disease management as appropriate Complete special assignments and projects instrumental to the function of the department Required Skills 2+ years of experience in HEDIS, Quality Improvement, Member Outreach and/or Health Coaching in a Managed Care environment Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or related health field Knowledge of Community, State and Federal laws and resources Previous experience working with Healthcare Management Systems Microsoft Office/Suite proficient (Excel, Outlook, Word, etc.) Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Desired Skills 2+ years of experience in Social work One of the following licenses / certifications: Licensed Clinical Social Worker (LCSW); Licensed Social Worker (LSW); Certified Social Worker (C-SW); Certified Social Worker in Health Care (C-SWHC); and, Licensed Clinical Social Worker Certified (LCSW-C) Bilingual (English and Spanish)

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Coding educator jobs are important at every healthcare facility, because billing and clinical professionals need to be kept up to date on the latest coding guidelines and practices. Without a working knowledge of how to document procedures, healthcare professionals won’t be able to keep an accurate account of patient information. Coding educator jobs are in place to make sure everyone adheres to the proper protocols, which helps with tracking diseases, managing medications, determining costs and getting reimbursements.

Training is the primary function of coding educator jobs. You’ll be responsible for instructing your staff on current coding techniques, medical terminology and other related information. This involves setting up training programs, developing a curriculum and leading the sessions. You can teach using a variety of methods, which is what makes coding educator jobs creative and exciting. Deliver presentations, put together comprehensive guidebooks, give your staff sample problems or all of the above.

Coding education careers are more than just training though. You’ll need to review your staff’s work regularly to make sure they’re doing what you taught them. So if you love learning about coding updates and communicating those changes to others, the opportunities you find here will be perfect for you.