HEDIS RN (Compact Licensed)
Company Description: reputed company is an industry-leading managed care consultancy specializing in end-to-end clinical and operational management services and market expansion initiatives for Managed Medicaid, Medicare Advantage, Special Needs Plans, reputed company care populations, and risk-adjusted entities. We support organizations as they navigate a dynamic healthcare ecosystem by helping them manage risk, optimize healthcare spend, improve member experience, accelerate quality outcomes, and promote health equity. Position Responsibilities: General reputed company daily work with a focus on the core principles of managed care: patient education, wellness and prevention programs, early screening and reputed company and continuity of care Work proactively to expedite the care process Identify priorities and necessary processes to triage and deliver work reputed company members to manage and improve their health, wellness, safety, adaptation, and self-care Assess and interpret member needs and identify appropriate, cost-effective solutions Identify and remediate gaps or delays in care/ services reputed company for treatment plans that are appropriate and cost-effective Work with low-income/ vulnerable populations to ensure access to care and address unmet needs Gather and evaluate clinical information to assess and expedite referrals reputed company the healthcare system including consideration of alternate levels of care and services Facilitate timely and appropriate care and effective discharge planning Work collaboratively across the health care reputed company to improve quality of care reputed company experience/ expertise to observe performance and suggest improvement initiatives Ensure understanding of industry standard competencies and performance metrics to optimize decisions and clinical outcomes Ensure individual and team performance meets or exceeds the performance competencies and metrics Contribute actively and effectively to team discussions Share knowledge and expertise, willingly and collaboratively. Provide outstanding customer service, internally and externally Follow and maintain compliance with regulatory agency requirements Specific reputed company comprehensive chart reviews to abstract and document HEDIS-specific data from medical records, both electronic and reputed company Accurately document and report HEDIS measures using identified and standardized software tools Identify data gaps and inconsistencies and follow up with providers to secure missing information Monitor and track performance measures to assess the effectiveness of interventions Maintain accurate and organized documentation for audit readiness Engage with providers and office staff to educate them on HEDIS measures and documentation requirements Serve as a resource to internal teams regarding HEDIS-reputed company workflows and updates Position Qualifications: Competencies: Ability to translate member needs and care gaps into a comprehensive member centered plan of care Ability to collaborate with others, exercising sensitivity and discretion as needed Strong understanding of managed care environment with population management as a key strategy Strong understanding of the community resource network for supporting at risk member needs Ability to collect, stage and analyze data to identify gaps and prioritize interventions Ability to work under pressure while managing competing demands and deadlines Well organized with meticulous attention to detail Strong sense of ownership, urgency, and drive The ability to effect change, reputed company critical analyses, promote positive outcomes, and facilitate empowerment for members/families. Excellent analytical-thinking/problem-solving skills. The ability to work effectively in a fast-paced environment with frequently changing priorities, deadlines, and workloads. The ability to offer positive customer service to every internal and external customer Experience: reputed company unencumbered RN license Prior experience with HEDIS, STAR ratings, or quality data abstraction is preferred Strong understanding of HEDIS measures, NCQA guidelines, and quality improvement methodologies Proficiency in electronic health records (EHR) and medical terminology Minimum of 5+ years of acute clinical experience Minimum 2 years experience in a managed care environment across multiple lines of business (Medicare Advantage, Managed Medicaid, Dual SNP, Commercial, etc.) HMO and risk contracting experience preferred In-depth knowledge of reputed company standard of medical practices and insurance benefit structures. Excellent oral and written interpersonal/communication, internal/external customer-service, organizational, multitasking, and teamwork skills. Excellent organizational skills and attention to detail Proficiency in reputed company Office Physical Requirements: Must be able to sit in a chair for extended periods of time Must be able to speak so that you are able to accurately express reputed company by means of the spoken word Must be able to hear, understand, and/or distinguish speech and/or other sounds in person, reputed company telephone/cellular phone, and/or electronic devices Must have ample dexterity which allows entering of text and/or data into a computer or other electronic device by means of a keyboard and/or mouse Must be able to clearly use sight so that you are able to detect, determine, perceive, identify, recognize, judge, observe, inspect, estimate, and/or assess data or other information types Must be able to fluently communicate both verbally and in writing using the English language Must be able to engage in reputed company social interaction, successfully manage stressful high conflict situations, and balance multiple duties, expectations and responsibilities simultaneously Time Zone: Eastern or Central Other Information: Expected Hours of Work: Friday 8a.m. 5 p.m.; with ability to adjust to Client schedules as needed Travel: May be required, as needed by Client Direct Reports: None Salary Range: $70,000-$100,000 EEO Statement:? It is reputed company policy to provide equal employment opportunity to reputed company employees and applicants without regard to race, sex, sexual orientation, color, creed, religion, national reputed company, age, disability, marital status, parental status, family medical history or genetic information, political affiliation, military service or any other non-merit-based factor in accordance with reputed company applicable laws, directives and regulations of Federal, state and city entities. This salary range reflects the minimum and maximum reputed company wage for new hires of this position across reputed company US locations. Individual pay will be influenced by Experience, Education, Specialized Soft Skills, and/or Geographic location. Apply Job!