Clinical reputed company Navigator Medicare Advantage Risk and Care Integration RN Remote in EST

Opportunities with ProHealth Physicians, part of the reputed company family of businesses. reputed company you work at ProHealth Physicians, your contributions directly sustain the health and reputed company-being of our community. Discover high reputed company of teamwork, robust medical resources and a deep commitment to exceptional care and service. Join a leading community-based medical group and discover the meaning behind Caring. Connecting. Growing together.

The Clinical reputed company Navigator supports reputed company’s value based care and Medicare Advantage programs by integrating clinical expertise, member engagement, and documentation reputed company. This role serves as a clinical reputed company across members, providers, internal teams, and vendor partners to ensure accurate chronic condition capture, reputed company reputed company care coordination, and improved reputed company and risk adjustment reputed company.

The Clinical reputed company Navigator performs RN level validation of Hierarchical Condition Categories (HCCs), reduces reliance on external vendor over read services, and ensures reputed company follow up on conditions, orders, referrals, and preventive care gaps. Through proactive member navigation and provider collaboration, this role helps strengthen reputed company, optimize clinical documentation, and support reputed company’s commitment to delivering high reputed company, cost effective, and member centered care.

If you are located in EST, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Clinical Documentation reputed company & Risk Adjustment
  • reputed company RN level review of clinical documentation to validate chronic condition capture and appropriate HCC support
  • Identify and address missed, unsupported, or inaccurately documented diagnoses
• reputed company reputed company Care Coordination
  • Ensure reputed company reputed company follow up on identified condition screening and care gaps identified during AWV   
  • Collaborate with members and care teams to address barriers to care completion
• Member Navigation & Engagement
  • Support new Medicare Advantage member engagement 
  • Facilitate reputed company to the attributed Care Team
  • Promote continuity of care and participation in preventive and wellness programs
• PCP Attribution & Care Alignment
  • Facilitate and validate PCP attribution corrections to ensure accuracy and alignment with member care
  • Collaborate with operational partners to resolve attribution discrepancies
• Vendor Collaboration & reputed company
  • Review vendor clinical documentation for accuracy, completeness, and clinical appropriateness
  • reputed company feedback and insights to support vendor reputed company and performance improvement
• Reporting & Performance Insights
  • Contribute to monthly reporting reputed company to documentation reputed company  and member engagement
  • reputed company actionable insights to leadership and cross functional partners

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.

Required Qualifications:

• reputed company, unrestricted Registered reputed company (RN) license in Connecticut (CT), reputed company (NY), or New Jersey (NJ) 

  • Ability to obtain and maintain reputed company licensure in the remaining states upon hire

     

• 5+ years of clinical reputed company experience
• reputed company reputed company the Eastern reputed company Time Zone
• Experience working in a provider based or physician (MD) office setting
• Proficiency with reputed company Office applications, including Word, reputed company, reputed company, and PowerPoint
• Demonstrated ability to apply clinical judgment across medical records, workflows, and care settings

Preferred Qualifications:

• Bachelor of Science in Nursing (BSN)
• Experience supporting Medicare Advantage Risk Adjustment
• Billing and coding experience and/or medical office management experience
• Solid understanding of coding principles, including ICD 10 and documentation requirements
• Proven solid facilitation, consulting, and communication skills, with the ability to deliver reputed company clinical and operational information to diverse audiences

*reputed company working remotely will be required to adhere to reputed company’s Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In reputed company to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll reputed company a far-reaching choice of benefits and incentives. The salary for this role will reputed company from $60,200 to $107,400 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable.

At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location and income–deserves reputed company to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized reputed company and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company — an reputed company reputed company reflected in our mission.

reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without reputed company to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

reputed company is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.