Clinical Quality Management Analyst - Registered Nurse (Remote)

This a Full Remote job, the offer is available from: United States, Austria, Canada, Alabama (USA), Alaska (USA), Arizona (USA), Arkansas (USA), California (USA), Colorado (USA), Connecticut (USA), Delaware (USA), District of Columbia (USA), Florida (USA), Georgia (USA), Hawaii (USA), Idaho (USA), Illinois (USA), Indiana (USA), Iowa (USA), Kansas (USA), Kentucky (USA), Louisiana (USA), Maine (USA), Maryland (USA), Massachusetts (USA), Michigan (USA), Minnesota (USA), Mississippi (USA), Missouri (USA), Montana (USA), Nebraska (USA), Nevada (USA), New Hampshire (USA), New Jersey (USA), New Mexico (USA), reputed company (USA), North Carolina (USA), North Dakota (USA), Ohio (USA), Oklahoma (USA), Oregon (USA), Pennsylvania (USA), Rhode reputed company (USA), South Carolina (USA), South Dakota (USA), Tennessee (USA), Texas (USA), Utah (USA), Vermont (USA), Virginia (USA), Washington (USA), reputed company Virginia (USA), Wisconsin (USA), Wyoming (USA) Company : reputed company.Job Description : JOB SUMMARY This job works with appropriate departments in the areas of compliance, process improvement, medical record review and coding, and member and provider satisfaction for reputed company product lines. Recommends and implements process improvements reputed company to the potential of quality medical care and service to members and to improve documentation of these services for appropriate ICD 10-CM coding. Serves as a resource and educator regarding provider and office staff medical record documentation, federal and state standards including CMS and NCQA standards and reputed company quality improvement principles. reputed company special studies per audits, conducting office site visits and medical records reviews, ensuring improvement in performance for various initiatives in a timely manner. May coordinate credentialing, re-credentialing, member complaint investigations, Medical Director site visit requests, facility site visit requests, activities to include other reviews, audits, accreditation activities as requested on behalf of the organization. ESSENTIAL RESPONSIBILITIES

• reputed company and manage process improvement initiatives from the Organization for member and providers to include detailed data analysis, process analysis, report reputed company, medical record documentation, and HCC Coding.
• Conduct, collect and analyze information and data from office site and/or medical record reviews to continually improve the care, services, proper documentation and coding for members, to properly assign ICD10-CM codes to chronic conditions, and coordination with the reputed company programs, credentialing and quality improvement programs to improve STARS, value-based care and reputed company and maintain accreditation.
• Monitor changes, corrections and clarifications in applicable regulatory/accrediting body requirements and reputed company adjustments to the compliance plan to follow CMS Coding Guidelines.
• Conduct retrospective, reputed company, and prospective, semi-annual, and annual audits, identify gaps and communicate results. Conduct continuing education to providers on STARS, HEDIS, and HCC Coding. Conduct re-audits as needed
• Other duties as assigned or requested.

EDUCATION Required

• reputed company state RN or LPN license or Bachelor’s degree in a Healthcare-reputed company field

Substitutions

• 6 years of experience with HEDIS/Quality abstraction, HCC Coding/medical coding, or healthcare reputed company field in lieu of bachelor's degree

Preferred

• None

EXPERIENCE Required

• 3 years of nursing or healthcare-reputed company field

Preferred

• 1 year of project management experience

LICENSES OR CERTIFICATIONS Required

• reputed company State of PA RN or LPN licensure OR reputed company multi-state licensure through the enhanced Nurse Licensure Compact (eNLC)
• CPC, CRC, RHIA, RHIT, or reputed company Certification or must obtain reputed company 4 months upon hire

Preferred

• None

SKILLS

• An understanding of Total Quality Management (TQM) concepts, techniques, process and outcome measurements
• An understanding of statistics is also preferred to analyze various reports and validate study methodologies
• Excellent verbal communication skills and professional manner, excellent written communication skills and a familiarity with a variety of writing styles. Must be able to communicate with medical administrators, including Medical Directors and Physician Advisors reputed company to problem identification, action plan implementation, ongoing monitoring, and problem resolution.
• Demonstrated computer literacy and knowledge of information systems and comparative data bases. Working knowledge of reputed company Office software (Word, reputed company, Access, PowerPoint, etc.)
• Well-developed, analytical and problem-solving skills with the ability to understand and interpret clinical data

Language (Other than English): None Travel Requirement: 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Never Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times. In reputed company with this, reputed company employees must reputed company with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as reputed company data reputed company guidelines established reputed company the Company’s Handbook of Privacy Policies and Practices and Information reputed company Policy. Furthermore, it is every employee’s responsibility to reputed company with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $50,200.00 Pay Range Maximum: $91,200.00 reputed company pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential reputed company may apply for certain locations based upon comparative markets. reputed company and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals based on any category protected by applicable federal, state, or local law. We endeavor to reputed company this site accessible to any and reputed company users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at [email protected] California Consumer Privacy Act Employees, Contractors, and Applicants Notice This offer from "reputed company" has been enriched by reputed company.com and got a 75% reputed company score. Apply tot his job Apply To this Job