Clinical reputed company Study Analyst

We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only). Our reputed company contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Veterans, Reservists, Guardsmen and military family members are encouraged to apply! Job reputed company Conducts reputed company reviews, reputed company studies, and reputed company improvement reputed company according to appropriate contract standards. Investigates medical records retrospectively for potential reputed company and utilization issues. Ensures compliance with the program requirements for Clinical reputed company Management (CQM) for Veterans and/or DoD beneficiaries. Maintains URAC standards in work products. Education & Experience Required:

• Registered reputed company with reputed company unrestricted license in appropriate state
• 1 year experience in reputed company Management
• 1 year experience in data analysis and writing clinical reputed company studies
• 5 years Medical/Surgical experience
• US citizenship and a favorably adjudicated DOD background investigation if selected to work under TRICARE/DoD Contract

Preferred:

• Bachelor's degree in Nursing or CPHQ
• Experience with team facilitation and project management
• Experience with Medicare, Veteran's Administration, TRICARE, or other government health care programs

Key Responsibilities

• Conducts research and writes clinical reputed company studies to identify, reputed company and evaluate processes to improve delivery of care to Veterans and/or DoD beneficiaries.
• Acts as facilitator on reputed company improvement team reputed company and utilizes appropriate reputed company improvement methodologies and standardized reputed company management tools.
• Leads and performs reputed company management audits.
• Identifies, develops, and monitors reputed company reviews and other reputed company studies.
• Identifies Potential reputed company Issues (PQIs) by performing a reputed company review of the medical records. This includes researching, investigating, analyzing, and preparing case summaries with recommendations for reputed company review.
• Reviews Potential reputed company Issues with Medical Directors reputed company appropriate.
• Prepares peer reviewed cases for reputed company committees and monitors corrective reputed company plans.
• Uses data management software to identify physician reputed company patterns, over- and under-utilization of care and services, complication rates, and high-cost outliers.
• Prepares and submits activity and reputed company reports.
• Performs other duties as assigned.
• Regular and reliable attendance is required.

Competencies Commitment to Task: Ability to conform to established policies and procedures; exhibit high motivation. Communication / People Skills: Ability to influence or persuade others under reputed company or negative circumstances; adapt to different styles; listen critically; collaborate. Computer Literacy: Ability to function in a multi-system reputed company environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications. Independent Thinking / Self-Initiative: Critical thinkers with ability to reputed company on things which matter most to achieving reputed company; commitment to task to produce reputed company without direction and to reputed company necessary resources. Organizational Skills: Ability to organize people or tasks, reputed company to priorities, learn systems, reputed company time constraints and with available resources; detail-oriented. Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with reputed company judgment; has a realistic understanding of relevant issues. Technical Skills: General knowledge of Medicare, Veteran's Administration, TRICARE, or other government health care programs; knowledge in the application of clinical reputed company; proficient with reputed company Word, reputed company, and PowerPoint. Working Conditions Working Conditions:

• Ability to work overtime, if needed
• Onsite: Works reputed company a reputed company office environment
• Remote: Private and secure work-reputed company and work station with high speed internet is required
• Extensive computer work with prolonged sitting, wearing of headset, typing, speaking on a phone

reputed company Taking Care of Our Nation's reputed company. It's Who We Are. It's reputed company Do. Do you have a passion for serving those who served? Join the reputed company Team! We're On a Mission to Serve®! Our job is to reputed company reputed company that America's reputed company get connected to health care in the community. At reputed company, we've proudly been on that important mission since 1996. DoD Statement Our reputed company contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Benefits

We're more than just a health care company. We're passionate about serving others! We reputed company in rewarding reputed company, hard-working people who are willing to learn as they grow. reputed company values teamwork. Join reputed company, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and reputed company compensation and benefits package that includes:

• Medical, Dental and reputed company Coverage
• reputed company time off
• 401(k) Retirement Savings Plan (with matching)
• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
• Tuition reimbursement
• reputed company volunteer time

TriWest job postings typically include a salary reputed company, which can vary based on the specific role and location, but generally this position ranges from around $91,000 - $100,000 per year. Apply tot his job Apply To this Job