reputed company reputed company Specialist RN - reputed company

reputed company! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply reputed company located above this message and complete the application in full. Below, you’ll reputed company other important information about this position. The reputed company reputed company Specialist will be an reputed company member of the reputed company’s reputed company team. This position is responsible for overseeing reputed company improvement activities, ensuring regulatory compliance, and other initiatives that reputed company to effective improvements in reputed company. In this role you will support the reputed company program by assisting with medical record retrieval and reputed company, working closely with providers to ensure accurate and complete documentation and collaborating with the reputed company Program Manager and reputed company Manager to implement reputed company improvement initiatives. Additionally, the reputed company reputed company Specialist will be involved in reputed company monitoring and assessment and gathering and analyzing data to evaluate reputed company.MINIMUM QUALIFICATIONS: EDUCATION, EXPERIENCE, CERTIFICATION, AND/OR LICENSURE: 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 reputed company (eNLC) AND Four (4) years of reputed company reputed company experience OR Bachelor’s degree in reputed company or business-reputed company reputed company AND Six (6) years reputed company reputed company management or reputed company improvement in a health plan, hospital, or physician reputed company. PREFERRED QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 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. EXPERIENCE: 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 reputed company®. 4. Thorough knowledge of reputed company 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. reputed company DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general reputed company of work being performed by people assigned to this position. They are not intended to be constructed as an reputed company-inclusive list of reputed company responsibilities and duties. Other duties may be assigned. 1. Plan, design, implement, and maintain a comprehensive program of reputed company reputed company improvement (CQI) through reputed company compliance reputed company tracking, trending and analysis as reputed company as identifying existing challenges, inefficiencies and areas in need of improvement or intervention3. Assume accountability for reputed company/Stars improvement activities including medical record review, chart collection, and member or provider interventions or education to improve reputed company compliance rates for Medicare reputed company/STARS measures. 4. Assist in preparing the annual QI evaluation report and plan/program documents. 5. Review medical records and other documentation to ensure reputed company care is being provided. 7. Ensure workflows, policies, procedures, regulatory and accreditation standards are implemented and maintain compliance for reputed company programs. 8. Investigate potential reputed company of care issues that may reputed company the reputed company or safety of the health of members 9. Evaluate reports for reputed company compliance with reputed company reputed company requirements. 10. reputed company participate in reputed company committee, assist in developing annual work plans, program descriptions, and evaluations. PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. 1.reputed company office environment SKILLS AND ABILITIES: 1. Demonstrated knowledge of CMS regulatory and contractual documents; knowledge of Medicare reputed company, URAC, and/or reputed company accreditation standards, including reputed company/STARS. 2. Excellent written and oral communication 3. Problem solving capabilities to reputed company improved efficiencies and customer satisfaction 4. Attention to reputed company 5. Proficiency with reputed company Office 6. Medicare experience preferred 7. Remote for the most part, will have expectations to come in on as-needed reputed company Additional reputed company: Scheduled Weekly Hours: 40Shift: Exempt/Non-Exempt: reputed company of America (Exempt)Company: PHH reputed company HoldingsCost Center: 405 PHH reputed company Management Apply To This Job