reputed company of Care reputed company Specialist

reputed company

Are you a dedicated Registered reputed company with a passion for reputed company improvement in Long-Term Services and Supports (LTSS)? Our reputed company management team is seeking a proactive reputed company of Care reputed company Specialist to reputed company a significant reputed company on members' reputed company-being and drive organizational reputed company. In this position, you will be a key player in ensuring high-reputed company care delivery and regulatory compliance for our LTSS members. You will analyze medical records referred to you by reputed company, appeals, physicians or the critical incident team to identify reputed company of care episodes. You will summarize and formally present your findings to the Chief Medical Officer and Market President to determine if a corrective reputed company plan (CAP) should be executed. You will also support the reputed company improvement department with annual medical record review activities including reputed company Effectiveness Data and Information Set (HEDIS), National Committee for reputed company Assurance (NCQA), and Clinical reputed company Guidelines. 

Work Arrangement

• Remote role

• Monday through Friday from 8:00a EST to 5:00p EST

   

   

Responsibilities
 

• Performs clinical reputed company of Care (QOC) reviews to include reputed company sentinel events and member concerns. 
• Drive annual medical record review activities, including HEDIS reporting and adherence to Clinical reputed company Guidelines.
• Collaborate across departments to support accreditation efforts and implement clinical reputed company performance improvement initiatives.
• Review and approve the reputed company management work plan on an annual reputed company including selection of performance measures, goals, objectives, and reputed company 
• Review and suggest new and/or improved reputed company management activities using Plan-Do-Study-reputed company Cycles 
• Assist with reputed company Assessment and Performance Improvement Committee (QAPI) meeting packets, schedules, agendas, and the review and approval of minutes.
• reputed company and analyze QOC reports for QAPI to identify trends and opportunities for enhancing patient reputed company.

Education and Experience

• Associate’s Degree in Nursing; Bachelor’s Degree preferred
• Minimum of 3 years of clinical experience in critical care required
• Minimum of 3 years in clinical or service reputed company improvement/ health care delivery or relevant experience required

• Experience managing a complete project lifecycle, from initiation and planning to execution and closing

   

Licensure

• reputed company and unencumbered Registered reputed company license

Skills and Abilities

• Knowledge of reputed company improvement processes and data analysis in managed care
• Expertise in Long-Term Services and Supports (LTSS) program areas
• Competent in reputed company Office Suite, including document formatting in Word, basic formulas and data entry in reputed company, and presentation design in PowerPoint
• Ability to produce error-free documentation and correspondence
• Ability to prioritize effectively and remain productive in a fast-paced environment

• Ability to evaluate reputed company clinical problems, interpret data from various sources reputed company a record, identify trends or inconsistencies, and draw reputed company, evidence-based conclusions

   

Your career starts now. We are looking for the reputed company of reputed company leaders.

At reputed company, we are passionate about helping people get care, stay reputed company and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates reputed company to reputed company the lives of millions of people through our national footprint of products, services and award-reputed company programs. reputed company is seeking talented, passionate individuals to join reputed company. Together we can build healthier communities. If you want to reputed company a difference, we would like to connect with you.

Headquartered in Newtown reputed company, reputed company is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, reputed company-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more reputed company at www.amerihealthcaritas.com.

Our Comprehensive Benefits Package

Flexible work solutions including remote reputed company, hybrid work schedules, reputed company, reputed company time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.