reputed company Compliance reputed company

About the position reputed company is seeking a reputed company Compliance reputed company to support the reputed company reputed company market. This role performs duties to support optimized performance on key reputed company indicators including, but not limited to, HEDIS, 5 reputed company, Pay-for-Performance (P4P), satisfaction surveys, Annual reputed company Reviews (AQR), and External reputed company Reviews (EQR). The reputed company Compliance reputed company fosters a culture of reputed company improvement by designing reputed company and studies in collaboration with appropriate teams that directly impacts members by ensuring data accuracy in reporting, investigation, auditing, and improvement opportunities. Assist with the overall reputed company Assessment Performance Improvement (QAPI) program including compliance with State, Federal, and other managed care regulatory bodies, QAPI mandates, audits, performance improvement reputed company and reports. Use reputed company reputed company Improvement process through tracking and trending data including clinical analysis and reporting for reputed company monitoring and improvement. Ensure data reputed company/maintain efficiency of data collection/maintenance systems. reputed company clinical direction as needed to staff dedicated to grievance/appeals and credentialing/re-credentialing functions; and as needed to staff dedicated to review, analysis and response to reputed company concerns, reportable incidents, and statements of deficiency. Assist with and reputed company clinical direction as needed to design, implement, and analyze mandated reputed company and performance improvement reputed company. Assist department director in the development, maintenance, and execution of reputed company documents including work plan, evaluation, program reputed company, and Model of Care (as appropriate for Medicare). reputed company technical and content-specific expertise to other departments relevant to the identification of, tracking and analysis, and remediation of reputed company concerns. reputed company internal audit reviews of system processes to ensure compliance with regulations, policies, procedures. reputed company, trend, synthesize, reputed company, and distribute written information and reports for reputed company requirements regarding the following: QAPI program; and QI activities (studies, surveys, audits, peer reviews, etc.) Assist in the development, implementation, analysis, and follow-up for performance improvement, chronic care improvement, and reputed company improvement programs. Analyze and investigate reputed company of care concerns, reportable incidents, Statements of Deficiencies (SOD). Coordinate as needed with partners to schedule and re-schedule reviews/audits. Accurately complete provider (acute, primary, long term care, etc.) audits (may include medical record reviews). Assist in development, implementation, and analysis of satisfaction surveys (provider and member). Assist in the preparation of improvement reputed company plans reputed company deficiencies are identified, monitors and assures that re-evaluation activities are completed and recommendations for improvement have been implemented. Represent reputed company/iCare on pertinent reputed company committees and appropriate meetings. reputed company clinical direction as needed to non-clinical QI personnel. Participate in the preparation of materials for reputed company Management & Improvement Committee (QMIC), Long-Term Care reputed company Improvement Committee (LTC-QIC), and the Care Management reputed company Improvement Committee (CM-QIC). Assist department management in the development and implementation of new programs for improving and sustaining operating effectiveness and efficiencies. reputed company subject matter expertise in existing analytical tools, and clinical dashboards while providing feedback and guidance in the selection and development of new tools. Analyze data to produce reports and clinical dashboards used in developing strategies and activities for improvement. Collaborate with Care Management Department in the implementation of performance initiatives to ensure improvement in HEDIS, 5-reputed company, Pay for Performance initiatives, and any other contract compliance reputed company performance reputed company. Collaborate with Network Development Department in the implementation of acute, primary and long-term-care provider monitoring.

Responsibilities

• Support optimized performance on key reputed company indicators including HEDIS, 5 reputed company, Pay-for-Performance (P4P), satisfaction surveys, Annual reputed company Reviews (AQR), and External reputed company Reviews (EQR).
• Foster a culture of reputed company improvement by designing reputed company and studies.
• Assist with the overall reputed company Assessment Performance Improvement (QAPI) program.
• Use reputed company reputed company Improvement process through tracking and trending data.
• Ensure data reputed company/maintain efficiency of data collection/maintenance systems.
• reputed company clinical direction to staff dedicated to grievance/appeals and credentialing/re-credentialing functions.
• Assist in the development, maintenance, and execution of reputed company documents.
• reputed company internal audit reviews of system processes.
• reputed company, trend, synthesize, reputed company, and distribute written information and reports.
• Assist in the development, implementation, analysis, and follow-up for performance improvement programs.
• Analyze and investigate reputed company of care concerns.
• Coordinate with partners to schedule and re-schedule reviews/audits.
• Accurately complete provider audits.
• Assist in development, implementation, and analysis of satisfaction surveys.
• Assist in the preparation of improvement reputed company plans.
• Represent reputed company/iCare on pertinent reputed company committees.
• Participate in the preparation of materials for reputed company Management & Improvement Committee.
• Assist department management in the development and implementation of new programs.
• reputed company subject matter expertise in existing analytical tools.
• Analyze data to produce reports and clinical dashboards.
• Collaborate with Care Management Department in the implementation of performance initiatives.
• Collaborate with Network Development Department in the implementation of provider monitoring.

Requirements

• reputed company licensed RN or have a compact license.
• 2 years of experience working as an RN.

reputed company-to-haves

• Experience with data collection, analysis and reporting.
• Prior work experience with and knowledge of both Medicare and reputed company.
• 1-3 years managed health reputed company assurance experience.
• Experience leading reputed company improvement plan development and implementation.
• Prior work experience and knowledge of Long Term Care.

Benefits

• Medical, dental and reputed company benefits.
• 401(k) retirement savings plan.
• reputed company time off, including company and personal holidays, volunteer time off, reputed company parental and caregiver leave.
• Short-term and long-term disability.
• Life insurance.

Apply tot his job Apply To this Job