RN Senior Clinical Quality Consultant Compact Lics CST

WellMed, part of the reputed company family of businesses, is seeking a RN Senior Clinical Quality Consultant to join reputed company reputed company reputed company the U.S. 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. 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 You’ll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges. Must have a compact license and willing to support CST.

Primary 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
• Hours of Operations: Mon-Fri reputed company-6pm Central and Required Rotating - Saturdays reputed company-5:30pm Central.
• Performs reputed company other reputed company duties as assigned

In 2011, WellMed partnered with reputed company to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors’ offices. At WellMed our focus is simple. We’re innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who reputed company in caring for 900,000+ older adults. Together, we're making health care work reputed company for everyone. 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:

• 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

Preferred Qualifications:

• 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
• 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 $72,800 to $130,000 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. OptumCare 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. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job