RiverSpring Health Plans, is part of a group of long term care affiliates under the brand name of RiverSpring Living. RiverSpring Living provides a full range of care solutions including nursing home care, managed long term care, assisted living programs, senior housing, rehabilitation services and specialized services such as elder abuse prevention and memory care. Collectively, RiverSpring Living empowers over 18,000 patients, residents and members to live forward every day. RiverSpring Health Plans is looking for a full time Clinical Quality Coordinator to join our dynamic team.
The Clinical Quality Coordinator supports quality assurance and performance improvement activities including, but not limited to, analyzing clinical data to identify trends and opportunities, recommending improvements and serving as a subject matter expert for the organization. The position is responsible for investigating clinical grievances and quality of care concerns for all RiverSpring Health Plans product lines. S/he will coordinate with RiverSpring Health Plans’ staff to ensure the completion and submission of documents related to grievance, appeal, incident and quality improvement activities within regulatory guidelines. Collaborates with Quality and IT staff in the analysis of clinical data.
Ideal candidate must have a Bachelor’s Degree in a Nursing. Current valid New York State license as Registered Professional Nurse. Minimum of two years of experience in a managed care setting. Care Management, Quality, Utilization Management and/or Grievance and Appeals experience. Demonstrated knowledge of Medicare and Medicaid regulations. Strong analytical skills. Effective oral and written communication skills. Strong organizational skills. Thorough knowledge of personal computer, especially proficiency with Microsoft Word, PowerPoint, and Excel. Ability to work and manage problems independently.
Requisition ID: 2021-4275
Street: 80 West 225th Street
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