Quality Risk Improvement Coordinator
2 weeks ago
DescriptionJob Schedule:
Full TimeStandard Hours:
40Job Shift:
Shift 1Shift Details:
Work whereevery momentmatters.
Every day, almost 30,000 Hartford HealthCare employees come to work with one thing in common: Pride in what we do, knowing every moment matters here.
We invite you to become part of Connecticuts most comprehensive healthcare network as a Quality Improvement Coordinator.
Hartford HealthCare at Home, the largest provider of homecare services in Connecticut, has been fulfilling our mission for more than 115 years.
Our Person-Centered Care Model allows our employees to learn and grow within our organization, all while providing integrated support to the patient.
As part of Hartford HealthCare, we leverage cutting edge technology to provide quality care in our clients home.
Most importantly, our employees are appreciated for the real differences they make in both the lives of their clients and their clients families.
Basic Purpose of the Position:
** Manages appeals at the branch level including clinical documentation review, training, and guidance
of clinical staff to ensure accurate reimbursement, regulatory compliance and the delivery of outcome-based, quality, cost effective care.
In general, most of the time will be spent in the following activities:
**Monitor Advanced Beneficiary Notices and denials as it relates to medical necessity requirements.
**Identify and evaluate denials to determine specific issues and patterns that need to be addressed with the facility.
**Investigate all payer denials and take appropriate action including but not limited to appeals, corrected billing
and chart reviews.
**Document patient accounting system with all denial activity and actions taken.
**Compile monthly denial reports.
**Maintain all data elements related to denials in the Compliance 360 module.
**Other duties as assigned by supervisor
**Facilitates record audits and process of care investigations, trends outcome data (satisfaction, utilization andclinical), develops and implements plans of action to ensure quality improvement, reimbursement and regulatory compliance.
**Reviews, calculates, and analyzes identified data processed by other team members as it relates to clinical documentation and quality of care. Develops and facilitates performance improvement teams and quality initiatives across the agency.
** Assist Quality teams with adverse event investigations, root cause analysis and development of best practices for the agency.
** For clinicians identified by Clinical Team Manager and Clinical Development Specialists provide reviews and processes certification/recertification and resumption of care orders ensuring accurate documentation and appropriate development of the plan of care.
** Collaborates with Clinical Team Manager and other case managers to support the Patient Centered Care Model including case conferencing, review of documentation and focused education to the clinical team.
** Provides staff guidance in making clinical and case management decisions that are cost effective and focused on clinical outcomes and operational performance indicators.
** Conducts education and training sessions related to utilization, reimbursement and regulatory compliance.
** Performs monthly pre-billing audits for Medicare, Medicare and Hospice
** Takes the lead on Additional Documentation Requests (ADR), government and payer audits to ensure documentation supports payer requirements and to ensure submission is timely
** Develops training to staff to improve clinical documentation
** Ensures standard work minimizes risk for denials
** Participates in quality assurance audits, audits, appeals and committees & projects as needed.
** Demonstrates the ability to research regulations and legal requirements on reimbursement issues and to train staff appropriately.
** Demonstrates the ability to work well with others and to educate clearly and concisely.
** Maintains a flexible schedule to meet the needs of the agency.
Qualifications
Licensure:
Registered Nurse with a license to practice in the State of
Connecticut
Education:
Graduate of an Associates degree or diploma program in Nursing; graduate of National League of Nursing-approved BSN program, preferred
Experience:
Three years clinical homecare experience. Managed care or case management experience required.
Proficient in Oasis, record review, home care regulations and use of quality tools. Computer literate.
Demonstrated ability to work with teams and individuals in providing clear, understandable direction and guidance. Excellent written and verbal communication skills.
We take great care of careers
With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth.
Here, you are part of an organization on the cutting edge helping to bring new technologies, breakthrough treatments and community education to countless men, women and children.
We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance.
Every moment matters.
And this isyour moment.
by Jobble
-
Clinical Quality Improvement Specialist
4 weeks ago
Woodbury, United States Northwell Health Full timeJob Description Participates in interdisciplinary and process improvement teams to identify potential future uses of the information systems and potential improvements in the current use of the systems. Serves as a nursing informatics resource, to individuals and teams within Patient Care Services. Job Responsibility * Knowledgeable of Performance...
-
Clinical Quality Improvement Specialist
2 weeks ago
Woodbury, United States Northwell Health Full timeParticipates in interdisciplinary and process improvement teams to identify potential future uses of the information systems and potential improvements in the current use of the systems. Serves as a nursing informatics resource, to individuals and teams within Patient Care Services. Job Responsibility - Knowledgeable of Performance Improvement methodology...
-
Clinical Quality Improvement Specialist
3 weeks ago
Woodbury, United States Northwell Health Full timeJob Description Participates in interdisciplinary and process improvement teams to identify potential future uses of the information systems and potential improvements in the current use of the systems. Serves as a nursing informatics resource, to individuals and teams within Patient Care Services. Job Responsibility * Knowledgeable of Performance...
-
Risk Management Consultant-greater Ny Metro/long
3 weeks ago
Woodbury, United States Utica Mutual Insurance Company Full time**The Company** At Utica National Insurance Group, 1,400 employees countrywide take our corporate promise to heart every day: To make people feel secure, appreciated, and respected. Utica National Insurance Group is an "A" rated $1.5B award-winning, nationally recognized property & casualty insurance carrier. Operating along the Eastern half of the United...
-
Underwriter II
4 weeks ago
Woodbury, United States CardWorksMerrick Bank Full timeUnderwriter II (UW), Merchant Underwriting & Risk Merrick Bank, 135 Crossways Park Drive, Woodbury, New York, United States of America Req #9291 Tuesday, April 2, 2024 Merrick Bank employees share in our mission to delight our customers and empower underserved consumers to achieve their credit goals. In return, we delight our associates; ensuring they are...
-
Underwriter II
4 weeks ago
Woodbury, United States Merrick Bank Full timeJob Description Job Description Merrick Bank employees share in our mission to delight our customers and empower underserved consumers to achieve their credit goals. In return, we delight our associates; ensuring they are noticed, heard, appreciated and understand the importance of their role(s). For over 20 years, our Guiding Principles of; doing the right...
-
Underwriter II
4 weeks ago
Woodbury, United States Merrick Bank Full timeJob DescriptionJob DescriptionMerrick Bank employees share in our mission to delight our customers and empower underserved consumers to achieve their credit goals. In return, we delight our associates; ensuring they are noticed, heard, appreciated and understand the importance of their role(s). For over 20 years, our Guiding Principles of; doing the right...
-
Underwriter II
3 weeks ago
Woodbury, United States Merrick Bank Full timeJob DescriptionJob DescriptionMerrick Bank employees share in our mission to delight our customers and empower underserved consumers to achieve their credit goals. In return, we delight our associates; ensuring they are noticed, heard, appreciated and understand the importance of their role(s). For over 20 years, our Guiding Principles of; doing the right...
-
eCommerce Marketing Coordinator
4 weeks ago
Woodbury, United States Winholt Equipment Full timeWinholt Equipment in Woodbury, NY is looking for a Full-time eCommerce Marketing Coordinator who will be responsible for coordinating all e-commerce activities to drive awareness, new customer acquisition, engagement, and revenue for Winholt. This well-rounded and digital-savvy individual will help lead the day-to-day execution of the e-commerce business and...
-
eCommerce Marketing Coordinator
3 weeks ago
Woodbury, United States Winholt Equipment Full timeWinholt Equipment in Woodbury, NY is looking for a Full-time eCommerce Marketing Coordinator who will be responsible for coordinating all e-commerce activities to drive awareness, new customer acquisition, engagement, and revenue for Winholt. This well-rounded and digital-savvy individual will help lead the day-to-day execution of the e-commerce business and...
-
Accounts Payable Coordinator
4 days ago
Woodbury, United States Kaufman Dolowich LLP Full timeOverview: Kaufman Dolowich, an AV-rated® firm designated one of the “Best Companies to Work For” among U.S. law firms by U.S. News & World Report, is seeking an Accounts Payable Coordinator with a minimum of 2+ years, law firm background a plus. The Accounts Payable Coordinator will utilize their knowledge and administrative skills to help the finance...
-
Accounts Payable Coordinator
3 weeks ago
Woodbury, United States Kaufman Dolowich LLP Full timeOverview: Kaufman Dolowich, an AV-rated® firm designated one of the “Best Companies to Work For” among U.S. law firms by U.S. News & World Report, is seeking an Accounts Payable Coordinator with a minimum of 2+ years, law firm background a plus. The Accounts Payable Coordinator will utilize their knowledge and administrative skills to help the finance...
-
Solutions Architect
3 weeks ago
Woodbury, United States Clever Devices Ltd. Full timeJob DescriptionJob DescriptionAs THE leader in transit technology, Clever Devices' vision is to make meaningful contributions to worldwide mobility. Our goal is to be the leading provider of exciting technology that improves the quality of mobility in communities around the world. We are continuing to grow, and are looking for a Solutions Architect.While...
-
Solutions Architect
3 weeks ago
Woodbury, United States Clever Devices Ltd. Full timeJob DescriptionJob DescriptionAs THE leader in transit technology, Clever Devices' vision is to make meaningful contributions to worldwide mobility. Our goal is to be the leading provider of exciting technology that improves the quality of mobility in communities around the world. We are continuing to grow, and are looking for a Solutions Architect.While...
-
Casual Physical Therapist
3 weeks ago
Woodbury, United States Fairview Health Services Full timeOverview Be a part of our collaborative M Health Fairview Rehabilitation team at Woodwinds Hospital! We are seeking a casual physical therapist to join us. In collaboration with patients and families, the physical therapist is responsible for providing safe and effective delivery of patient care within scope of practice. This includes examination,...
-
Casual Physical Therapist
4 weeks ago
Woodbury, United States Fairview Health Services Full timeOverview Be a part of our collaborative M Health Fairview Rehabilitation team at Woodwinds Hospital! We are seeking a casual physical therapist to join us. In collaboration with patients and families, the physical therapist is responsible for providing safe and effective delivery of patient care within scope of practice. This includes examination,...
-
Accounts Payable Coordinator
6 days ago
Woodbury, United States Kaufman Dolowich LLP Full timeOverview: Kaufman Dolowich, an AV-rated® firm designated one of the “Best Companies to Work For” among U.S. law firms by U.S. News & World Report, is seeking an Accounts Payable Coordinator with a minimum of 2+ years, law firm background a plus. The Accounts Payable Coordinator will utilize their knowledge and administrative skills to help the finance...
-
Care Coordinator
4 weeks ago
Woodbury, United States Infinite Health Collaborative (iHealth) Full timeDescription The Care Coordinator will support the clinic and physician care team by providing administrative and patient care services including scheduling appointments with providers or ancillary departments to ensure coordinated care for patients, scheduling for the infusion center, co-pay assistance, prior authorization, and verifying insurance coverage....
-
Care Coordinator
3 weeks ago
Woodbury, United States Infinite Health Collaborative (iHealth) Full timeDescription The Care Coordinator will support the clinic and physician care team by providing administrative and patient care services including scheduling appointments with providers or ancillary departments to ensure coordinated care for patients, scheduling for the infusion center, co-pay assistance, prior authorization, and verifying insurance coverage....
-
Care Coordinator, Rheumatology
3 weeks ago
Woodbury, United States Infinite Health Collaborative (iHealth) Full timeDescription The Care Coordinator will support the clinic and physician care team by providing administrative and patient care services including scheduling appointments with providers or ancillary departments to ensure coordinated care for patients, scheduling for the infusion center, co-pay assistance, prior authorization, and verifying insurance coverage....
