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Quality Review Nurse - MLTC - RN Registered Nurse

Job Description

Compass Healthcare Consulting & Placement is conducting a search for an experienced Quality Review Nurse for a large Managed Long Term Care Plan (MLTC) located in Queens, NY. Qualified candidates will have at least 2 years of Care Management experience within a Managed Long Term Care environment, have a strong knowledge of MLTC rules and guidelines and an eye for detail. Competitive Salary and excellent benefits! Easy commute by car.


Quality Review Specialist - Fair Hearings RN - Registered Nurse


Requirements:


This position is responsible for quality assurance, accuracy and overall integrity of the care management records and documentation completed by Care Management staff. This role is to ensure compliance with NYS DOH and CMS regulations through development of auditing tools, specifically validating all data collected. Analyzes collected audit data, identify trends for staff re-training and implementing corrective action plans in collaboration with Clinical management staff. Provides support to Directors, Managers and Supervisors to insure that all documentation and reporting requirements are prepared and maintained in a professional and well-coordinated manner. This position is responsible for reviewing, collecting and preparing evidence packets for all scheduled Fair Hearings. managed care n care management


Qualifications:



  • Graduate from an accredited School of Nursing. BSN or BS degree preferred.

  • Minimum of two (2) years care management experience required.

  • Computer literate, Windows, Excel, Word, Visio and data base programs required. PowerPoint preferred.

  • Licensed with current Registration to practice as Registered Professional Nurse in NYS.

  • Strong interpersonal and organizational skills.

  • Excellent written and verbal communication skill.

  • Excellent analytic skills, interpretation of data.

  • Possess strong critical thinking skills and knowledge of Medicare and Medicaid regulations.

  • Work effectively within interdisciplinary team environment.

  • Ability to set priorities and to handle multiple assignments.

  • Working knowledge of audit techniques and methodologies.

  • Working knowledge of State and Federal regulations.


Qualified Candidates Please Apply Now for Immediate Consideration!


 


 



Company Description
Compass Healthcare Consulting & Placement is a Permanent Placement Recruitment Company, owned and operated by a Registered Nurse with over 25 years of Operations, Management and Recruitment experience. We pride ourselves in professional placement for Healthcare providers. All Job Inquires are confidential. Working with Reputable Employers in New York City, Westchester County and Long Island. Compass is available 7 days as week to speak with you evening phone conferences are available as requested.



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