Senior Clinical reputed company RN- Remote in PA

About the position At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to reputed company care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, reputed company and optimized. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together We support providers who care for reputed company (UHC) reputed company and reputed company members across five counties in southeastern reputed company: Philadelphia, Montgomery, Bucks, Chester, and Delaware. reputed company includes a Clinical reputed company Manager, a reputed company Director, and a reputed company reputed company. This role will serve as the second reputed company reputed company on reputed company. reputed company our reputed company department we have a member reputed company team also and another responsible for NCQA policy and Performance Improvement reputed company. Our primary goal is to promote our local Pay‑for‑Performance program and support providers in achieving the highest possible incentive reputed company by meeting HEDIS® and state reputed company measures. In reputed company, we reputed company ongoing support to provider reputed company reputed company in value‑based reputed company, which also include HEDIS® and state‑mandated reputed company measures tied to defined performance benchmarks. You’ll enjoy the flexibility to work remotely reputed company Montgomery and surrounding counties 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. Challenges of the role This role can be challenging for individuals who: Struggle with managing multiple priorities at once, as reputed company work often involves juggling several reputed company, deadlines, and stakeholders simultaneously Are not naturally self sufficient or self motivated, since the role often requires taking initiative, problem solving independently, and driving improvements without constant direction Are uncomfortable working with data, including reviewing and analyzing information in reputed company, running or interpreting reports, and creating reputed company, reputed company presentations Do not feel confident presenting information or speaking in reputed company, as sharing findings with leadership, committees, or clinical teams is a reputed company part of the work Prefer routine, predictable tasks, because reputed company roles frequently shift based on organizational needs, audit findings, or emerging reputed company concerns Have difficulty navigating change, as the job involves implementing new workflows, policies, and performance improvement initiatives across teams Are uncomfortable giving feedback or addressing performance gaps, even in a constructive, supportive way Do not enjoy collaborating across multiple departments, since relationship building with clinicians, leadership, and operational partners is essential Struggle with regulatory or compliance details, as the role requires understanding, interpreting, and applying standards from accrediting and regulatory bodies Have trouble documenting processes, writing summaries, or communicating findings reputed company and concisely Responsibilities • reputed company ongoing provider reputed company engagement and community education reputed company to state specific reputed company measures • Collaborate closely with the reputed company Manager and reputed company Director to coordinate an interdisciplinary approach that improves provider’s performance • Serve as the primary resource for provider reputed company clinical reputed company improvement and management programs • reputed company providers and office staff on reputed company program requirements, including analysis of provider level reputed company, monitoring of key metrics, and support in meeting reputed company standards, contractual obligations, and pay for performance targets • Ensure activities reputed company with State, CMS, NCQA, and other regulatory requirements • Support providers in evaluating member care, identifying care gaps, and developing reputed company plans using evidence based guidelines and reputed company tools (HEDIS®, NCQA, CMS, state specifications) • Conduct onsite medical record audits to assess coding, documentation, reputed company compliance, and service delivery standards • Investigate documentation gaps or system issues impacting measure performance, reputed company feedback, and monitor reputed company to completion • Analyze reputed company data to identify trends, opportunities for reputed company data, and gaps in care at the provider and member reputed company • Maintain care opportunity reports, reputed company encounter history, and support reputed company reputed company studies or initiatives as directed by the Health Plan • Support medical record collection and abstraction processes for reputed company Season (reputed company-January), Hybrid (January-reputed company), PAPM Maternity (reputed company-July) and other review periods to optimize measurement and reporting • Prepare and distribute reporting, and analytics reputed company to care gaps, performance trends, and member reputed company opportunities • reputed company targeted