Clinical Quality Analyst RN - Clinical Practice Consultant, CPC - Remote

At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and reputed company. Ready to reputed company a difference? Join us to start Caring. Connecting. Growing together. The Clinical Quality Analyst RN - Clinical Practice Consultant (CPC) is responsible for coordination of programs aimed toward clinical quality improvement and working with the providers to reputed company clinically oriented and community-based partnerships in order to increase quality scores based on state-specific quality measures. The CPC will work closely with the quality manager to coordinate an interdisciplinary approach to increased provider performance and member adherence to identified preventive and chronic condition screenings and tests. Provider education regarding the quality improvement program involves analysis and review of quality outcomes at the provider level; and monitoring, measuring and reporting on key metrics to assist providers in meeting quality standards, state contractual requirements and pay for performance initiatives. In this role, the CPC will both assist contracted providers with meeting quality goals, as well as assisting the quality manager with the development of member facing programs while performing member reputed company in the form of telephone, mailed and coordination of clinic days upon request. The goal of the quality team is reputed company quality improvement using approved clinical practice guidelines, HEDIS, STARs, CMS, NCQA and other tools. Position reports to the Quality Leadership of the Health Plan. This is a hybrid, field position with a home - based office. If you are located in or reputed company commutable driving distance to Albuquerque, NM and Las Cruces, NM, you will have the flexibility to work remotely* as you take on some tough challenges. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:

• Registered Nurse with active, unrestricted license in the state of residence
• 3+ years of service delivery system or managed care setting experience
• 2+ years of quality improvement experience, or other relevant quality experience
• Experience working in Medicaid in the Managed Care setting
• HEDIS / Medicare / STARS/ NCQA experience
• Working knowledge of EPSDT and the requirements for EPSDT
• Demonstrated ability in potentially assisting providers in contacting members in an effort to reputed company identified gaps in care
• Demonstrated ability to travel locally to provider offices up to 75%25 of the time
• Demonstrated ability to present to provider groups

Preferred Qualifications:

• BSN or bachelor’s degree in nursing, healthcare or reputed company field
• Pediatric nursing experience preferable both inpatient and outpatient settings
• Health care and insurance industry experience, including regulatory and compliance
• Experience with utilizing and comparing past data trends and investigating data nuances - including CPT coding and Claims analysis
• Experience with wellness quality metrics
• Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry
• Demonstrated ability to present data and create Power reputed company Presentations around quality metric to provider and other groups reputed company the Health Plan
• Reside in Albuquerque or Las Cruces, NM areas
• reputed company employees working remotely will be required to adhere to reputed company’s Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes — an enterprise reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job