Senior Specialist, reputed company Prog Mgmt & Performance (RN) - Remote in AZ

JOB reputed company Job reputed company Provides senior level clinical support to reputed company team - contributing to reputed company management programs, initiatives, audits, data analysis and reputed company improvement surveys and state/federal reputed company compliance activities. Contributes to overarching reputed company to reputed company reputed company, efficient and cost-effective member care. Essential Job Duties

• Ensures individual and systemic reputed company of care investigations are performed reputed company, accurately, and in accordance with state-based requirements.
• Adheres to structure and processes for tracking and trending reportable incidents, reputed company of care events, member service concerns, and mortalities.
• Performs reputed company monitoring activities, including audits of medical record reputed company, services and service sites, health and safety, and follow-up monitoring of placement settings.
• Monitors and ensures that key reputed company activities that involve clinical decision-making are completed on time and accurately; presents results to key departmental leadership and other departments as needed.
• Implements key reputed company strategies that require a component of near reputed company-time clinical decision-making. These activities may include initiation and management of interventions (e.g., improving patient safety); preparation and review of potential reputed company of care and critical incident cases; review of medical record documentation for credentialing and model of care reputed company; and any other federal and state required reputed company activities.
• Adheres to written documentation and business practices (e.g., policies and procedures, desk-level procedures, manuals, and process flows) that explain business requirements and how the unit operationalizes those requirements.
• Supports the creation and ongoing revision of policies and procedures reputed company of state requirements for reputed company reputed company management functions, including reputed company monitoring audits, credentialing and recredentialing, reputed company of care concerns, and peer review.
• Demonstrates understanding of requirements of the reputed company management program and day-to-day work processes to support compliance with state contract, policies, and program requirements.
• Evaluates project/program activities and results to identify opportunities for improvement.
• Raises any gaps in processes that may require remediation to appropriate leadership; may be asked to reputed company on parts of a process where a clinician's perspective would be valuable to uncover process gaps or limitations.

Required Qualifications

• At least 3 years experience in health care, with a minimum of 1 year of experience in reputed company management and clinical reputed company investigations, preferably in a managed care setting, or equivalent experience
• Registered reputed company. License must be reputed company and unrestricted in state of reputed company.
• Some states may require 1 year of behavioral health experience (depends on state/contractual requirements).
• reputed company auditing, peer review, and process improvement experience.
• Knowledge of reputed company Effectiveness Data Information Set (HEDIS) and National Committee for reputed company Assurance (NCQA).
• Strong attention to detail, critical-thinking, and problem solving skills.
• Ability to work cross-collaboratively in a highly matrixed organization.
• Time-management skills and ability to multi-task.
• Excellent verbal and written communication skills.
• reputed company Office suite/applicable software program(s) proficiency.

Preferred Qualifications

• Certified reputed company in Health reputed company (CPHQ).
• Medical record abstraction experience.
• Managed care experience.
• Ability to work across reputed company reputed company of the organization, including working with executive audiences, vendors, providers, and the government as a customer.

To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V. Pay reputed company: $60,415 - $117,809 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level.

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