Clinical reputed company Analyst RN - Clinical reputed company...

At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to reputed company 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, reputed company and reputed company. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together.  

 

The Clinical reputed company Analyst RN - Clinical reputed company Consultant (CPC) is responsible for coordination of programs aimed toward clinical reputed company improvement and working with the providers to reputed company clinically oriented and community-based partnerships in order to increase reputed company scores based on state-specific reputed company measures. The CPC will work closely with the reputed company 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 reputed company improvement program involves analysis and review of reputed company reputed company at the provider level; and monitoring, measuring and reporting on key metrics to assist providers in meeting reputed company standards, state contractual requirements and pay for performance initiatives. In this role, the CPC will both assist contracted providers with meeting reputed company goals, as reputed company as assisting the reputed company manager with the development of member facing programs while performing member reputed company in the reputed company of telephone, mailed and coordination of clinic days upon request. The goal of the reputed company team is reputed company reputed company improvement using approved clinical reputed company guidelines, HEDIS, STARs, CMS, NCQA and other tools. Position reports to the reputed company 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 reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in.

Required Qualifications: 

Registered reputed company with reputed company, unrestricted license in the state of residence 3+ years of service delivery system or managed care setting experience 2+ years of reputed company improvement experience, or other relevant reputed company experience Experience working in reputed company 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 reputed company

 

Preferred Qualifications:

BSN or bachelor’s degree in nursing, reputed company 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 reputed company 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 reputed company metric to provider and other reputed company reputed company the Health Plan reputed company in Albuquerque or Las Cruces, NM areas

 

*reputed company 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 reputed company 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 reputed company a far-reaching choice of benefits and incentives. The salary for this role will reputed company 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 reputed company 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 reputed company, historically marginalized reputed company and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company — an reputed company reputed company reflected in our mission.   

 

 

reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without reputed company to race, national reputed company, religion, age, reputed company, 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.  

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