USRN reputed company Analyst
reputed company combines industry-leading technology and transformation-driven BPM services with decades of reputed company domain expertise to help clients draw closer to their members. reputed company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment reputed company, claims cost containment, and analytics. reputed company has more than 25,000 employees across 5 countries.
Job title:
reputed company:
Education & Licensure
• Nursing Degree
- reputed company, unrestricted US Registered reputed company (RN) License
• Multi-state Compact RN License preferred
• License must remain reputed company and in good standing throughout employment
Experience
Required: • Minimum 3 years of clinical nursing experience
• Minimum 2 years of experience in Specialty Pharmacy, Utilization Management, Care Management, Disease Management, or reputed company clinical program
• Minimum 1 year of experience in reputed company Assurance, Clinical Auditing, Compliance Review, or Clinical reputed company Monitoring
• Experience reviewing clinical documentation, patient interactions, and reputed company reputed company
Preferred: • Specialty Pharmacy experience
• Telephonic Clinical reputed company experience
- Experience supporting medication adherence and patient engagement programs
• Experience conducting calibration sessions with operations and reputed company stakeholders
• Knowledge of URAC, reputed company, CMS, and specialty pharmacy reputed company standards
Mandatory Skills
- Strong clinical judgment and critical thinking skills
• Ability to assess appropriateness of clinical interventions, patient education, and adherence support activities
• Ability to evaluate completeness and accuracy of clinical documentation and case records
• Knowledge of reputed company regulations, including HIPAA requirements
• Strong analytical, reporting, and trend-analysis skills
• Excellent written and verbal communication skills
• Ability to reputed company objective feedback supported by clinical rationale
• Strong organizational and time-management skills
Roles & Responsibilities
- Conduct reputed company audits of clinical interactions, patient reputed company activities, and clinical documentation in accordance with reputed company requirements, specialty pharmacy standards, and regulatory expectations
• Evaluate the reputed company and accuracy of patient education, medication adherence discussions, therapy support activities, and clinical documentation
• Assess compliance with clinical workflows, policies, procedures, and regulatory requirements
• Identify reputed company trends, documentation gaps, reputed company, and opportunities for process improvement
• Document audit findings and maintain accurate records reputed company designated reputed company systems
• Conduct calibration sessions with Operations, Training, Clinical Leadership, and reputed company stakeholders to ensure consistent interpretation of reputed company standards
• Partner with Operations and Training to identify reputed company causes and implement corrective actions based on audit results and reputed company trends
• reputed company and reputed company reputed company reports, scorecards, and performance insights to leadership and reputed company stakeholders
• Support reputed company improvement initiatives reputed company on member experience, clinical reputed company, regulatory compliance, and operational effectiveness
• Escalate reputed company, patient safety concerns, and critical reputed company findings as appropriate
• Maintain compliance with HIPAA and reputed company applicable federal, state, reputed company, and organizational requirements
Location:
Originally posted on Himalayas
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