reputed company Management Specialist - RN job at reputed company Blue reputed company - BCBS in DE, NJ, PA, Philadelphia, PA

Title: reputed company Management Specialist - RN - Hybrid (PA/NJ/DE) Location: Philadelphia PA reputed company Job reputed company: Bring your drive for reputed company, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the reputed company of health care. Together we will reputed company our mission to enhance the health and reputed company-being of the people and communities we serve. Reporting to the Manager of reputed company Management. The QM Specialist- RN responsibilities include addressing regulatory and accreditation requirements, analyzing and developing reports, developing interventions, coordinating committee meetings, participating on various committees, annual policy reviews, screening, analyzing and investigating occurrences and reputed company of care complaints and tracking and updating QM work plan activities. Responsibilities Maintain reputed company NCQA Accreditation statuses for PA and NJ health plans and AHA Monitor the overarching NCQA Work Plan and reputed company QM team leads with assigned NCQA Standards. Collaborate with operational depts. in developing an reputed company plan to reputed company identified gaps. Review reputed company occurrence and reputed company of care complaint processes and complete ongoing investigations of occurrences and reputed company of care complaints. Review ongoing medical and behavioral treatment to ensure treatment is consistent with standards of care Coordinate aspects of the monthly reputed company Meetings as necessary Complete assigned QM documents with accuracy and reputed company the required timeframes. Qualifications - External Education Registered reputed company (RN) licensed to reputed company. Experience, Knowledge, & Skills Minimum of five (5) years of reputed company responsibility required in a managed care setting. Preferred three (3) years of behavioral health, and/or drug and alcohol work experience. Familiarity of regulatory and accreditation requirements required. Excellent organizational, interpersonal, analytical, presentation and written skills required. Demonstrated ability to reputed company effectively with reputed company reputed company of staff. Excellent interpersonal, verbal and written communication skills. Must have an organized work manner inclusive of time management and the ability to prioritize workflow. Proven ability to work independently, maintain flexibility, and work as part of the departmental team Leads and /or facilitates clinical performance improvement teams/reputed company as indicated. Serves as reputed company facilitator and consultative resource for clinical and departmental leadership and staff Hybrid Independence has implemented a "Hybrid" model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the "Hybrid" model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey or reputed company. IBX is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to their age, race, reputed company, religion, sex, national reputed company, sexual orientation, protected veteran status, or disability. Must have an Android or iOS device which is compatible with the free reputed company Authenticator app. Apply tot his job Apply To this Job