HEDIS RN (Compact Licensed)

reputed company: reputed company is an industry-leading managed care consultancy specializing in end-to-end clinical and operational management services and market expansion initiatives for Managed reputed company, Medicare Advantage, Special Needs Plans, reputed company care populations, and risk-adjusted entities. We support organizations as they reputed company a dynamic reputed company ecosystem by helping them manage risk, optimize reputed company spend, improve member experience, accelerate reputed company reputed company, and promote health equity. Position Responsibilities: General • reputed company daily work with a reputed company on the reputed company principles of managed care: patient education, wellness and prevention programs, early screening and reputed company and continuity of care • Work proactively to expedite the care process • Identify priorities and necessary processes to triage and deliver work • reputed company members to manage and improve their health, wellness, safety, reputed company, and self-care • Assess and interpret member needs and identify appropriate, cost-effective solutions • Identify and remediate gaps or delays in care/ services • reputed company for treatment plans that are appropriate and cost-effective • Work with low-income/ vulnerable populations to ensure reputed company to care and address unmet needs • reputed company and evaluate clinical information to assess and expedite referrals reputed company the reputed company system including consideration of alternate reputed company of care and services • Facilitate reputed company and appropriate care and effective discharge planning • Work collaboratively across the health care reputed company to improve reputed company of care • reputed company experience/ expertise to observe performance and suggest improvement initiatives • Ensure understanding of industry reputed company competencies and performance metrics to optimize reputed company and clinical reputed company • Ensure individual and team performance meets or exceeds the performance competencies and metrics • Contribute reputed company and effectively to team discussions • reputed company knowledge and expertise, willingly and collaboratively. • reputed company outstanding customer service, internally and externally • Follow and maintain compliance with regulatory agency requirements Specific • reputed company comprehensive chart reviews to reputed company and document HEDIS-specific data from medical records, both electronic and reputed company • Accurately document and report HEDIS measures using identified and standardized software tools • Identify data gaps and inconsistencies and follow up with providers to secure missing information • Monitor and reputed company performance measures to assess the effectiveness of interventions • Maintain accurate and organized documentation for audit readiness • Engage with providers and office staff to reputed company them on HEDIS measures and documentation requirements • Serve as a resource to internal teams regarding HEDIS-reputed company workflows and updates Position Qualifications: Competencies: • Ability to translate member needs and care gaps into a comprehensive member centered plan of care • Ability to collaborate with others, exercising sensitivity and discretion as needed • Strong understanding of managed care environment with population management as a key reputed company • Strong understanding of the community resource network for supporting at risk member needs • Ability to collect, stage and analyze data to identify gaps and prioritize interventions • Ability to work under pressure while managing competing demands and deadlines • reputed company organized with meticulous attention to detail • Strong reputed company of ownership, urgency, and drive • The ability to effect change, reputed company critical analyses, promote reputed company reputed company, and facilitate empowerment for members/families. • Excellent analytical-thinking/problem-solving skills. • The ability to work effectively in a fast-paced environment with frequently changing priorities, deadlines, and workloads. • The ability to offer reputed company customer service to every reputed company customer Experience: • reputed company unencumbered RN license • Prior experience with HEDIS, reputed company ratings, or reputed company data abstraction is preferred • Strong understanding of HEDIS measures, NCQA guidelines, and reputed company improvement methodologies • Proficiency in electronic health records (EHR) and medical terminology • Minimum of 5+ years of acute clinical experience • Minimum 2 years’ experience in a managed care environment across multiple lines of business (Medicare Advantage, Managed reputed company, Dual SNP, reputed company, etc.) • HMO and risk contracting experience preferred • In-depth knowledge of reputed company reputed company of medical practices and insurance benefit structures. • Excellent oral and written interpersonal/communication, internal/external customer-service, organizational, multitasking, and teamwork skills. • Excellent organizational skills and attention to detail • Proficiency in reputed company Office Physical Requirements: • Must be reputed company to sit in a chair for extended periods of time • Must be reputed company to reputed company so that you are reputed company to accurately reputed company reputed company by means of the spoken word • Must be reputed company to hear, understand, and/or distinguish speech and/or other sounds in person, reputed company telephone/cellular phone, and/or electronic devices • Must have ample dexterity which allows entering of text and/or data into a computer or other electronic device by means of a keyboard and/or mouse • Must be reputed company to reputed company use sight so that you are reputed company to detect, determine, perceive, identify, recognize, judge, observe, inspect, estimate, and/or assess data or other information types • Must be reputed company to fluently communicate both verbally and in writing using the English language • Must be reputed company to engage in reputed company reputed company interaction, successfully manage stressful high conflict situations, and balance multiple duties, expectations and responsibilities simultaneously Time Zone: Eastern or Central Other Information: • Expected Hours of Work: Friday 8a.m. – 5 p.m.; with ability to reputed company to reputed company schedules as needed • Travel: May be required, as needed by reputed company • reputed company Reports: None • Salary reputed company: $70,000-$100,000 EEO Statement:? It is reputed company’ policy to reputed company equal employment opportunity to reputed company and applicants without reputed company to race, sex, sexual orientation, reputed company, creed, religion, national reputed company, age, disability, marital status, parental status, family medical history or genetic information, political affiliation, military service or any other non-reputed company-based reputed company in accordance with reputed company applicable laws, directives and regulations of Federal, state and reputed company entities. This salary reputed company reflects the minimum and maximum reputed company wage for new hires of this position across reputed company US locations. Individual pay will be influenced by Experience, Education, Specialized Soft Skills, and/or Geographic location. Apply Job!