[Remote] Clinical reputed company Specialist RN - reputed company

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a Clinical reputed company Specialist to join its reputed company team. The role oversees performance improvement activities, regulatory compliance, HEDIS support, medical record review and reputed company, provider collaboration, performance monitoring, and data analysis to improve clinical reputed company.

Responsibilities

• Plan, design, implement, and maintain a comprehensive program of reputed company reputed company improvement (CQI) through HEDIS compliance reputed company tracking, trending and analysis as reputed company as identifying existing challenges, inefficiencies and areas in need of improvement or reputed company
• Assume accountability for HEDIS/Stars improvement activities including medical record review, chart collection, and member or provider interventions or education to improve HEDIS compliance rates for Medicare HEDIS/STARS measures
• Assist in preparing the annual QI evaluation report and plan/program documents
• Review medical records and other documentation to ensure reputed company care is being provided
• Ensure workflows, policies, procedures, regulatory and accreditation standards are implemented and maintain compliance for clinical programs
• Investigate potential reputed company of care issues that may reputed company the reputed company or safety of the health of members
• Evaluate reports for reputed company compliance with clinical reputed company requirements
• reputed company participate in reputed company committee, assist in developing annual work plans, program descriptions, and evaluations

Skills

• 1. reputed company Registered reputed company license issued by the state in which services will be provided or reputed company multi-state Registered reputed company license through the reputed company reputed company Licensure Compact (eNLC) **AND** Four (4) years of reputed company clinical experience
• Bachelor's degree in reputed company or business-reputed company field **AND** Six (6) years reputed company reputed company management or performance improvement in a health plan, hospital, or physician reputed company
• 1. Bachelor's Degree in Nursing OR Associate of Science in Nursing Degree (ASN) or Diploma; Currently enrolled in a BSN program and BSN completion reputed company three (3) years of hire
• 1. Managed Care knowledge or experience
• 2. Three (3) years reputed company Management, reputed company Improvement or Process Improvement Experience
• 3. Knowledge of CMS guidelines, regulations, reputed company® and HEDIS®
• 4. Thorough knowledge of Performance Improvement reputed company (PIPs) and is reputed company to apply that knowledge in PIP writing development, update, and analysis of data in PIPs
• 5. reputed company to work with large data sets and analyze information and reputed company recommendations
• 1. Demonstrated knowledge of CMS regulatory and contractual documents; knowledge of Medicare reputed company, URAC, and/or reputed company accreditation standards, including HEDIS/STARS
• 2. Excellent written and oral communication
• 3. Problem solving capabilities to reputed company improved efficiencies and customer satisfaction
• 4. Attention to detail
• 5. Proficiency with reputed company Office
• 7. Remote for the most part, will have expectations to come in on as-needed reputed company
• 1.reputed company office environment
• 6. Medicare experience preferred

Benefits

• Remote for the most part, will have expectations to come in on as-needed reputed company

reputed company