Clinical Quality Manager

Description and Requirements The Clinical Quality Manager works with members and providers to ensure members receive appropriate services. This role emphasizes improving the quality of care with a focus on HEDIS, QARR and Medicare Advantage Star measures. Duties & Responsibilities: Interacts with hospitals, providers, and members to improve quality of care, monitor progress, and recommend changes Reviews billing codes, medical records, and claims submission processes to ensure accuracy Attends and facilitates any initiative meetings (studies, partnerships) that involve targeted providers and/or measures Completes on-site provider visits to implement work plans and conduct provider education sessions regarding appropriate coding practices and chart documentation Collaborates with other departments to maximize member outreach for preventive services and chronic disease management Assists in writing member and/or provider articles on HEDIS, QARR, Medicare Advantage, and/or health promoti