Job Description


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QA Clinical Coordinator

  • Ref: 307281
  • Type: Direct Hire
  • Location: Bronx, NY
  • Industry: Healthcare
  • Job Level: Senior
  • Pay: $60,000.00 - 65,000.00

Opportunity Description

 We have an exciting full-time Quality Assurance (QA) Clinical Coordinator opening.



Company Information

Our client is part of a group of long-term care affiliates that provide 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, they empower over 18,000 patients, residents, and members to live forward every day. They are located in a beautiful 4-story building with free parking available to employees.

You must be able to work onsite and be vaccinated against Covid19

Job Duties

The role is responsible for logging, tracking, and processing appeals, grievances, and incidents. The Specialist responds to written/verbal grievances, complaints, appeals, and disputes submitted by members and providers in accordance with NCQA, CMS, NY State, and other regulations. Types of correspondence handled by the individual will include, but are not limited to, correspondence, payment disputes, complaints/grievances, and appeals. Work requires exercising considerable independent judgment and initiative in performing case file investigation.


• As the department liaison by coordinating various departments to ensure grievances/incidents are processed timely and compliance requirements are maintained.

• Identify root cause or errors and develop resolutions plans, ensure prompt resolution of case reviews and issues.

• Process all levels of member and provider grievances/incidents, including assisting with escalated grievances/incidents (state/federal level).

• Receive, document, investigate, refer, resolve, and coordinate grievances/incidents/appeals.

• Initiate case files for each grievance/incident/appeal and ensure compliance with organizational and regulatory requirements.

• Ensure regulatory compliance, stringent timeframe requirements and accuracy standards are met.

• Develop correspondence communicating the outcome of grievances/ nonclinical incidents and appeals to enrollees and/or providers.

• Coordinate efficient functioning of day-to-day operations according to defined processes and procedures.

• Create and maintain accurate records documenting the actions and rationale for each grievance/incident or appeal decision.

• Complete and coordinate department audits and quality projects as assigned.

• Performs other duties as assigned or required.





 Bachelor's Degree required

Experience & Skills Required

The ideal candidate must have:

• Bachelor’s Degree required.

• 2 – 3 years of related work experience, must have grievance and appeals experience.

• Experience in a managed care/compliance environment preferred.

• Proficiency in MS Office applications (especially word processing, and database/spreadsheet) required.

• Excellent organizational skills.

• Excellent verbal and written communication skills.

• Problem solving and analytical skills.

• Outstanding attention to detail.

• Ability to speak effectively before customers or employees of an organization.

• Ability to read, write and speak English.

• Bilingual a plus to be able to speak another language.





Medical and Prescription Drug

Company-Paid Dental

Company-Paid Vision

Company-Paid Life Insurance and Accidental Death & Dismemberment

Company-Paid Short-Term Disability

Company-Paid Long-Term Disability

Health Care Flexible Spending Account

Dependent Care Flexible Spending Account

Employee Assistance Plan

Additional Life Insurance options for the employee and family members

Additional Disability options

403(b) Plan, with a generous employer contribution




Personal Days

Sick Days




Bereavement Days

Cell Phone Discount Plan

Commuter Plan

Jury Duty Days

Marriage Days

Pet Insurance Discount Plan

Tuition Assistance

Wellness Programs

Years of Service Awards


Other Information