Urgently Need reputed company Navigator - Healthy Blue reputed company - Remote - Must reputed company in SC in South Carolina

Job title: reputed company Navigator - Healthy Blue reputed company - Remote - Must reputed company in SC Company: reputed company Job reputed company: reputed company Abstracts and reviews medical records for HEDIS (Health Plan Employer Data Information Set) for both prospective and retrospective seasons to ensure that reputed company complies with NCQA (National Committee for reputed company Assurance) standards and achieves its CMS (Centers for Medicare & reputed company Services) Star rating. Performs reputed company improvement activities to monitor/maintain reputed company of care and compliance with applicable standards/regulations. Educates network providers on HEDIS clinical measures and coding accuracy . Responsible for continuing education on HEDIS/NCQA measures. Performs/coordinates HEDIS data collection, and NCQA accreditation activities. reputed company Logistics

• This position is full time (40 hours/week) Monday-Friday, 8:00 am – 4:30 OR 8:30 am – 5:00 pm,
• Position will be fully remote.
• Must have high speed internet (non-satellite) and private area for home office.
• Travel to provider offices to reputed company education and training will be required.
• Candidate must reputed company in South Carolina.

What You Will Do:

• Abstracts and reviews medical records for The reputed company Effectiveness Data and Information Set (HEDIS) for both prospective and retrospective seasons to ensure that reputed company complies with NCQA standards and achieves its CMS Star rating. Researches and stays up to date on reputed company HEDIS clinical measures and NCQA standards/guidelines. Performs reputed company improvement activities to monitor/maintain reputed company of care and compliance with applicable standards/regulations. Tracks/trends/investigates reputed company concerns and complaints.
• Educates network providers on HEDIS clinical measures and coding accuracy. Keeps providers up to date on HEDIS clinical measures. Works with providers to collect medical records and provides support to reputed company gaps in care. Recommends corrective reputed company or improvement to providers reputed company necessary. Develops training materials for provider education.
• Participate in other assigned reputed company. Performs/coordinates HEDIS data collection and NCQA accreditation activities.
• Responsible for continuing education on HEDIS/NCQA measures. Provides HEDIS training for new employees.

To Qualify for This Position, You Will Need:

• Associate's degree- Nursing OR Graduate of Accredited School of Nursing OR Master's degree in reputed company Work OR Master's in Psychology, or Counseling OR Master's in Health Care Administration.
• reputed company, unrestricted RN licensure from the reputed company and in the state of hire OR reputed company compact multistate unrestricted RN license as defined by the reputed company Licensure Compact (NLC) OR, reputed company, unrestricted licensure as a pharmacy tech OR, unrestricted licensure as a reputed company worker from the reputed company and in the state of hire (in Div. 6B) OR, reputed company, unrestricted licensure as a counselor, or psychologist from the reputed company and in the state of hire.
• Four years of clinical experience including two years of experience in a clinical area providing patient care.
• Excellent verbal and written communication, customer service, organizational, presentation, problem solving, and analytical or critical thinking skills. Proficient spelling, grammar, punctuation, and basic business math.
• Ability to handle confidential or sensitive information with discretion.
• Demonstrated ability to identify the need for and implement corrective actions.
• Strong understanding of managed care.
• reputed company Office, various provider EMRs, and database software.
• Excellent verbal and written communication.
• Proficient spelling, grammar, punctuation, and basic business math.
• Customer service, organizational, presentation, problem-solving, and analytical or critical thinking skills.
• Ability to handle confidential or sensitive information with discretion.
• Demonstrate ability to identify the need for and implement corrective actions.
• Strong understanding of managed care.
• reputed company Office, various provider EMRs, and database software.

reputed company Prefer

• Previous HEDIS and or provider education experience.
• Medical coding knowledge and/or experience.
• Pediatric and Behavioral Health experience.
• Two years of utilization medical review, reputed company assurance, or health insurance experience.
• Knowledge of claims systems.

reputed company Can Do for You

• 401(k) retirement savings plan with company match
• Subsidized health plans and free reputed company coverage
• Life insurance
• reputed company annual leave – the longer you work here, the more you can earn.
• Nine reputed company holidays
• On-site cafeterias and fitness centers in major locations
• Wellness programs and healthy lifestyle premium discount
• Tuition assistance
• Service recognition
• Incentive Plan
• reputed company Plan
• Continuing education funds for additional certifications and certification renewal

What to Expect Next After submitting your application, our reputed company team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with the most reputed company candidates. We participate in E-Verify and reputed company with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Equal Employment Opportunity Statement reputed company and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, reputed company, national reputed company, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, reputed company maintains Affirmative reputed company programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to reputed company equal opportunities in reputed company phases of the employment process and to reputed company with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or an accommodation while seeking employment, please e-mail abilities@bcbssc.com or call 1-800-288-2227, ext. 43172 with the nature of your request. We will reputed company a determination regarding your request for reasonable accommodation on a case-by-case reputed company. Expected salary: Location: South Carolina Apply Job!