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Quality Review & Staff Education Specialist

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MJHS

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Location:
United States , New York

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Category:
Nursing

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Contract Type:
Not provided

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Salary:

92276.31 - 115345.38 USD / Year
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Job Description:

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms. At MJHS, we are more than a workplace; we are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services. We foster collaboration, celebrate achievements, and promote fairness for all. Our contributions are recognized with comprehensive compensation and benefits, career development, and the opportunity for a healthy work-life balance, advancement within our organization and the fulfillment of having a lasting impact on the communities we serve.

Job Responsibility:

  • Assessment Quality Review Specialist and Staff Educator is responsible for quality assurance, accuracy and overall integrity of the UAS-NY assessment data and visit documentation completed by core team nurses as well as, business partners’ nurses
  • Performing assessment audits, identifying trends that require staff retraining, and implementing corrective action plans in collaboration with Clinical management staff
  • Responsible for ongoing orientation, training and education of Assessment Nurses conducting UAS-NY assessments
  • Participate in establishing educational modules for staff orientation and re-training
  • Travel as part of ongoing orientation, training and education, as well as to perform UAS-NY assessments on an as needed basis
  • Conduct Enrollment Visits follow up for HF nurses and business partners, including NTUC note completion, Visit Outcome Follow Up
  • Assist with completion of Deferral Calls, and Transfer Calls and notify appropriate parties of outcome
  • Maintain accurate productivity log of Enrollment processes follow-up
  • Prepare for RFS (Request for Service) and IDT (Interdisciplinary Team) meetings by conducting UAS-NY assessment review and relevant documentation conducted by core field staff and business partners to ensure correlation within the assessment and validation of Tasking Tool completion
  • Participate in RFS and IDT meetings, follow-ups with Assessment Nurses if documentations’ amendments are required
  • Identifies inconsistencies trends and provides suggestions for corrective action plan for identified assessment deficiencies to Field Assessment management

Requirements:

  • Baccalaureate degree in nursing required
  • Minimum of two (2) years clinical experience required
  • UAS-NY experience required
  • Requires a NYS Registered Nurse license and registration
  • Excellent analytical skills, interpretation of data
  • Strong critical thinking skills
  • Knowledge of Medicare and Medicaid regulations
  • Ability to set priorities and to handle multiple assignments
  • Working knowledge of audit techniques and methodologies
  • Working knowledge of State and Federal regulations
  • Travels to perform business partners training and clearance visits

Nice to have:

  • Master's degree in nursing, education or related field preferred
  • Managed Care experience preferred
What we offer:
  • Sign-on Bonuses OR Student Loan Assistance for clinical staff
  • FREE Online RN to BSN and MSN degree programs
  • Tuition Reimbursement for all full and part-time staff
  • Dependent Tuition Reimbursement for clinical staff
  • Generous paid time off, including your birthday
  • Affordable and comprehensive medical, dental and vision coverage for employee and family members
  • Two retirement plans! 403(b) AND Employer Paid Pension
  • Flexible spending
  • And MORE!
  • MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)

Additional Information:

Job Posted:
February 14, 2026

Employment Type:
Fulltime
Work Type:
Hybrid work
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