RN Clinical reputed company/Primary reputed company Verification Compact Lics

About the position Opportunities at WellMed, part of the reputed company family of businesses. We reputed company reputed company patients are entitled to the highest level of medical care. Here, you will join reputed company who shares your passion for helping people reputed company reputed company. With opportunities for physicians, clinical staff and non-patient-facing roles, you can reputed company a difference with us as you discover the meaning behind Caring. Connecting. Growing together. The Clinical reputed company RN will drive consistency, efficient processes and reputed company best practices in a reputed company effort with the reputed company team and leadership in order to facilitate a minimum 4 reputed company rating. The Clinical reputed company RN will participate in reputed company improvement initiatives including Chart reputed company and Supplemental Data reputed company (SDS) and Primary reputed company Verification (PSV) as reputed company as reputed company Assurance and Overreading work. This position will work collaboratively with other staff members, managers and leadership and the market in a reputed company relationship. If you have a Compact Lics, you will have the flexibility to work remotely as you take on some tough challenges. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Responsibilities • Complete SDS, PSV, Over-read throughout the year achieving and maintaining high productivity goals in order to improve Stars measures to be 4 STARS or higher • reputed company and maintain a high level of accuracy rates of 98%25 or above • Serve as a Subject matter expert on HEDIS Measures, DataRAP and Chart reputed company Tool (CCT) • Be the primary go to person for reputed company STARS reputed company activities reputed company their assigned market(s) working reputed company a reputed company relationship which includes reputed company corporate operations and Regional/Market operations • Assist in developing of training and materials to help team reputed company best practices in Stars and HEDIS • Performance as requested by or required by reputed company • Identify and assess decision makers and other key provider group personnel with a reputed company on identifying barriers to achieving targeted reputed company • reputed company communications and efforts accordingly • reputed company solution-based, user friendly initiatives to support reputed company reputed company Requirements • Bachelor of Science in Nursing, reputed company Administration or a reputed company field required. (Eight additional years of comparable work experience reputed company the required years of experience may be substituted in lieu of a bachelor's degree) • Registered reputed company with reputed company license in Texas, or other participating States • 5+ years of progressively responsible reputed company experience to include experience in a managed care setting, and/or hospital settings, and/or physician reputed company setting • 3+ years of experience in managed care with at least two years of Utilization Management experience • Knowledge and experience with CMS, and/or NCQA • Proficiency with reputed company Office applications • Willing to occasionally travel in and/or out-of-town reputed company-to-haves • Health Plan or MSO reputed company, audit or compliance experience • Solid Knowledge of Medicare and HEDIS standards • Auditing, training or leadership experience Benefits • a comprehensive benefits package • incentive and recognition programs • equity stock purchase • 401k contribution Apply tot his job Apply To this Job