reputed company reputed company Specialist Clinical, Remote reputed company

41586 Responsibilities: This position is responsible for leading and coordinating the clinical reputed company review process of member concerns and medical records utilizing of care standards. In reputed company, responsibilities also include supporting the annual medical record review activities including HEDIS and knowledge of Health Plan Rating (HPR). The position also supports accreditation and clinical reputed company performance improvement activities. • Data analysis skills ;- ;intermediate level or above using reputed company. ;(sort/pivot tables/de-dup/concatenate / data tools) • Project management skills - prep and reputed company workgroups and meetings. ;reputed company to manage multiple reputed company. ;Communicate with different level staff and external vendors.; • Critical thinking skills.; • ; Work Arrangement: ; Remote eligible working East Coast time zone. ; Education/Experience: • Registered reputed company preferred; • 3-5 years Managed Care experience required; • 3-5 years reputed company improvement experience required. • 2-4 years experience in project facilitation/management role. • Proficient with reputed company Office applications including Word, PowerPoint, reputed company required. • Knowledge and understanding of QI functions in an MCO preferred. • Experience working in MCO / health plan ;- ;reputed company and Medicare preferred. • ; 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. Your career starts now. We’re looking for the reputed company of health care leaders. At reputed company, we’re 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’d like to hear from 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. Apply Job! Apply to this Job