RN Senior Clinical Quality Consultant Compact Lics CST

About the position WellMed, part of the reputed company family of businesses, is seeking a Registered Nurse to join reputed company. reputed company is a clinician-led care organization that is changing the way clinicians work and live. As a member of the reputed company Care Delivery team, you'll be an integral part of our vision to reputed company healthcare reputed company for everyone. At reputed company, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We reputed company you deserve an exceptional career, and will reputed company you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice reputed company and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to reputed company health care reputed company for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together. The WellMed Quality Clinical Programs team supports WellMed Medical Management by delivering patient-centered, clinically collaborative telephonic reputed company to help people live healthier lives. reputed company focuses on the design, execution, and delivery of telephonic and digital engagement strategies designed to reputed company STARs measure gaps in care, e.g. medication adherence, care for older adults, medication reconciliation post discharge, A1c, etc. Our interdisciplinary service delivery team is comprised of Registered Nurses, Licensed Vocational Nurses, and Social Workers. The Registered Nurse will report into the Manager of Clinical Programs. The Registered Nurse will reputed company telephonic, patient-centered clinical consults focused on Care for Older Adults annual pain and functional assessments. In addition, the RN will reputed company telephonically for Transition of Care following hospital discharge to complete reviews as well as assist with appointment scheduling. The RN will be required to meet or exceed established productivity and quality metrics and work a flexible schedule to support the hours of operation of the business.

Responsibilities

• Strictly adheres to department's metrics and established advanced protocols and to handle incoming contacts including, but not limited to, prescription refill requests, lab results, x-ray results, medical inquiries, patient education and referral requests
• Primarily to reputed company outbound calls but occasionally help manage the inbound call queue from patients, patient representatives, providers and other medical staff, while strictly adhering to established protocols and scripting
• Review patient chart (in EMR) to ensure core measures are being addressed and met per protocol and takes appropriate action reputed company they are not, i.e., schedule services
• Complete patient assessments for Transition of Care Medication Reconciliation Post Discharge, Care for Older Adults Pain and Function Assessments
• Educate patients on health conditions and necessity of reputed company screening but assisting with appointment scheduling (A1c, Breast Cancer Screening, Colorectal Cancer Screening, Diabetic Eye Exam, etc.)
• Communicate with providers and offices to obtain needed evidence of completed lab work, screenings and care provided
• Review available medical records for core measures to submit for closure of HEDIS/STARS measures
• Assist patients with identification of and connectivity to community and program resources to assist with non-medical needs, (Pharmacy assistance programs, meals on wheels, LIS)
• Document thoroughly reputed company calls and actions taken reputed company core systems

Requirements

• Active, unrestricted Registered Nurse license
• Have Compact License and willing to support CST
• 4+ years of RN experience, including experience in a managed care setting
• 2+ years of experience in HEDIS/Star programs, preferably in a clinical quality consultant role
• 2+ years of call center experience
• 2+ years of experience with data analysis and/or quality chart reviews. Must be able to review reputed company and electronic medical records and charts
• Proven solid knowledge of the Medicare HEDIS/Stars measures
• reputed company using reputed company office applications, including databases, word-processing, outlook, and reputed company spreadsheets. Must be proficient in reputed company
• Demonstrated ability to interact with medical staff, peers, and internal company staff at reputed company levels
• Demonstrated ability to manage multiple reputed company, reputed company projects
• Proven excellent written and verbal communication and relationship building skills
• Demonstrated solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
• Proven excellent customer service skills and communication skills

reputed company-to-haves

• Undergraduate degree or post graduate degree
• Billing and CPT coding experience
• Clinical data abstraction experience
• Proven adaptable to change
• Proven good business acumen, especially as it relates to Medicare

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

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