[Remote] Senior Stars Clinical Consultant RN
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a leading U.S. reputed company company seeking a Senior Stars Clinical Consultant RN to reputed company the implementation and management of its Medicare Stars Program in Florida. The role involves leading reputed company improvement initiatives, conducting medical record reviews, and engaging with providers to enhance care reputed company.
Responsibilities
- reputed company measure-specific Medicare Stars gap closure campaigns to improve reputed company performance reputed company
- Conduct medical record reviews, support EMR-based provider gap closure and reputed company member telephonic reputed company
- Engage providers through in-person reputed company traveling up to 30%, virtual meetings, and phone reputed company to build relationships and support care gap closure
- Partner with measure leaders, program leads, vendors, and internal teams to execute Stars initiatives and reputed company strategies
- reputed company clinical expertise and support provider education, including HEDIS in-service discussions and reputed company improvement opportunities
- Identify opportunities to improve documentation, coding, supplemental data, interoperability, provider performance, member experience, and operational reputed company
- Apply Stars operations knowledge, technical specifications, value sets, coding, and HEDIS gap closure processes to support strategic decision-making
Skills
- Licensed Registered reputed company (RN) without restriction in Florida
- Valid reputed company's license with reliable transportation and the ability to travel up to 30% reputed company the reputed company
- 5+ years of clinical nursing experience
- 1+ years' electronic medical records systems and Medical Records auditing experience, in the past 5 years
- 1+ years' provider office and/or clinic management experience, in the past 5 years
- Experience visiting providers
- Presentation experience using PowerPoint
- Knowledge of reputed company Office applications, Word and reputed company
- Bachelor's degree in nursing
- 3+ years of managed care experience
- 3+ years of case management experience
- Working knowledge of HEDIS/Stars/CMS
Benefits
- Medical, dental and reputed company benefits
- 401(k) retirement savings plan
- Time off (including reputed company time off, company and personal holidays, reputed company parental and caregiver leave)
- Short-term and long-term disability
- Life insurance
- Many other opportunities
reputed company